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VNlit <br /> -- ,,,E <br /> -- _`_ ANTI - KICKBACK <br /> •�� City of Sunny Isles Beach <br /> "" 18070 Collins Avenue <br /> • <br /> �_o 0 <br /> r E o Sunny Isles Beach,FL 33160 <br /> o, .0 Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <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 /> By: M{fo <br /> Title: President <br /> The foregoing instrument was acknowledged before me this 1st day of <br /> May , 2012 , by Adolfo J. Cotilla, Jr.. AIA [name <br /> of person], as President [type of authority], for <br /> ACAI Associates, Inc. [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: l---- <br /> ,„.N, NolenPubliStabs ofF • Notary P blid JState of Florida <br /> Sandra Srnerkera <br /> • <br /> ,,,� MY Ccmmwion%1 21728 <br /> ficalaeeu Sandra Smerkers <br /> Print or Type Commissioned Name <br /> Personally Known V OR Produced Identification <br /> Type of Identification Produced <br /> DECEueEp 25.2010 7 of 7 <br /> City of Sunny Isles Beach I Request for Proposal No. 12-04-02 83 <br />