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0 °"NT <br /> i,\)n ANTI - KICKBACK <br /> v — n x <br /> x <br /> ® �V City of Sunny Isles Beach <br /> r,Loo + 18070 Collins Avenue <br /> '.� '• c+� Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> ® STATE OF FLORIDA <br /> ® COUNTY OF Broward ) <br /> • I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br /> • will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br /> • commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br /> ® by an officer of the corporation. <br /> O <br /> ® By: Dennis . Gior a <br /> ® Title: President <br /> 0 <br /> The foregoing instrument was acknowledged / <br /> [name <br /> ® of person], as Presrden+ [type of authority], for <br /> • Cawiniaore�ana Assoc is 5j Inc [name of party on behalf of whom instrument was <br /> executed]. <br /> ® AFFIX NOTARY STAMP HERE: 4.11 <br /> ® MARTHA EVANS <br /> NOTARY PUBLIC.STAB OF FLORIDA Notary Public — State of Florida <br /> ® COMMISSION A EE002677 <br /> EXPIRES 6/21/2014 <br /> '1N. T3 TNRu 1-ase-NOTARY, II <br /> ® Af�y1C, <br /> ® Print or Type Commissioned Name <br /> Personally Known ✓ OR Produced Identification <br />• Type of Identification Produced <br />• <br /> A <br /> 0 <br />• <br /> A <br /> DECEMBER 28,2010 7 of 7 <br />