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a <br /> 0 <br /> ® hV MNY i 1 e <br /> a <br /> ` ,id <br /> ANTI - KICKBACK <br /> ® ;; City of Sunny Isles Beach <br /> %� 18070 Collins Avenue <br /> • • <br /> '• •to•'Ya+ Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> 0 <br /> ® STATE OF FLORIDA ) <br /> • COUNTY OF Broward0 <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 /> 0 <br /> • By: Dennis . Gior <br /> ® Title: President <br /> 0 <br /> The foregoing instrument was acknowledged before me this /Qt`" day of <br /> • R pri I , 20by I- . i Csro rd • [name <br /> 0 of person], as ire sI e e ni- [type of authority], for <br /> . 6'ardan. Is . _. [name of party on behalf of whom instrument was <br /> • executed]. <br /> O <br /> ® AFFIX NOTARY STAMP HERE: <br /> S MARTHA EVANSPOTARY PUBLIC y V <br /> COMMISSI NDEE0STATC 0267" Notary Public — State of Florida <br /> COMMISSION A EEW2$77 <br /> ® EXPIRES 6/21/2014 <br /> ":INLED" U:ann-NoTARyt c� <br /> • ark het C-va/v1S <br /> • Print or Type Commissioned Name <br /> • Personally Known ✓ OR Produced Identification <br /> • Type of Identification Produced <br /> 0 <br /> 0 <br /> 0 <br /> O <br /> 0 <br /> DECEMBER 28,2010 7 of 7 <br />