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• <br /> • oitn. Il,F <br /> O'` <br /> tt ANTI - KICKBACK <br /> • - City of Sunny Isles Beach <br /> ® 18070 Collins Avenue <br /> i <br /> � '•rio� o�' Sunny Isles Beach,FL 33160 <br /> L• 'or,vn Telephone:(305)947-0606 Far(305)949-3113 <br /> • ANTI-KICKBACK AFFIDAVIT <br /> • <br /> • <br /> • STATE OF FLORIDA <br /> • COUNTY OF Broward <br /> • <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: Peter Moore, P.E., LEED <br /> • <br /> • Title: President <br /> • <br /> • The foregoing instrument was acknowledged before me this 30 day of <br /> • April , 20 12 by Peter Moore, P.E., LEED AP [name <br /> • of person], as President [type of authority], for <br /> • then Moore and Associates [name of party on behalf of whom instrument was <br /> executed]. <br /> • <br /> • AFFIX NOTARY STAMP HERY DA <br /> NOTARY PUBLIC-STA E <br /> • Kathryn J. Horrigan re-/z<air^ <br /> Commission#DD997048 No ry Pub is — State orFlorida <br /> • . 2 Expires: JUNE 01,2014 <br /> BONDED Tmi6 ATLANTIC B0NDLNG CO,INC <br /> • <br /> ka7Z4/ A) (TAA ,qq04) <br /> • Print or Type Commissioned Name <br /> 0 <br /> • Personally Known x OR Produced Identification <br /> • Type of Identification Produced <br /> 0 <br /> • <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> N±M <br /> 0 CH OD RE RIO.No.12-04-01 Continuing Professional Architectural&Engineering Services firms Only(CCNA) <br /> Category:Civil Engineering 7-11 <br /> 0 <br /> 6/SSOCIATES <br /> • <br />