Laserfiche WebLink
,$NY', <br /> O,-S _'��F, <br /> / ANTI - KICKBACK <br /> „J. _ s <br /> .- -t.-- ,��� City of Sunny Isles Beach <br /> \. ��i/ 18070 Coffins Avenue <br /> .�o�` Sunny Isles Beach,FL 33160 <br /> Of SO$ ' Telephone:(305)947-0606 Fax(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF _VOLUSIA _ ) <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 /> By: _Shailesh K. Patel Gtr^" <br /> Title: _Managing Member/ Principal_ <br /> ® The foregoing instrument was acknowledge before me this _3_ day of <br /> _May , 2012 , by 5r,\R-.1-4 K .to's [name <br /> of person], as [type of authority], for <br /> [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: n - ' <br /> ca \ J . �� <br /> Notary Public — StatE:'dfflorida <br /> Print or Type Commissioned Name <br /> e' out pp�yIF C.WIGGINS <br /> Personally Known N1 OR Produced Identification � IncoRA�ZONIE 14404 <br /> ,2015 <br /> Type of Identification Produced t.a EXPIRES: <br /> B pj $ice ber rs <br /> "East <br /> 411 <br /> DECEY9ER 26,2010 7o17 <br />