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ISVNNT ISIE <br /> f3 �� ANTI - KICKBACK <br /> :\ 'LL-F9 <br /> /:• City of Sunny Isles Beach <br /> \ T 18070 Collins Avenue <br /> 0 <br /> ''r )• r1.0° o+` Sunny Isles Beach,FL 33160 <br /> o, sue' ''' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> 1 ANTI-KICKBACK AFFIDAVIT <br /> I STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF MIAMI-DADE ) <br /> 1 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 /> Icommission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br /> by an officer of the corporation- <br /> 1 <br /> / <br /> By: _ <br /> / <br /> Title: Senior/---Preside t <br /> IThe foregoing instrument was acknowledged before me this Korth day of <br /> April , 20 12 by Carlos Mallol, P.E., DBA [name <br /> I of person], as Senior Vice President [type of authority], for <br /> CSA Central, Inc. [name of party on behalf of whom instrument was <br /> executed]. <br /> IAFFIX NOTARY STAMP HERE: <br /> I ,,••�a:a;;s,, DINA K. RHYMES Nota ublic — Sta a oda <br /> t.° 'os Notary Public -State of Florida <br /> a •'My Comm.Expires Aug 16,2014 <br /> I ---":F��2-0= Commissions DD 98605= Dina K. Rhymes <br /> ::io• Bonded Through National Notary Assn_ Print or Type Commissioned Name <br /> IPersonally Known x OR Produced Identification <br /> Type of Identification Produced <br /> I <br /> I <br /> I <br /> IDECEMBER 28.2010 7 of 7 <br />