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ICivil/Environmental Engineering 16-12 <br /> IsfNY,\x <br /> c ANTI - KICKBACK <br /> ".\ Tl= <br /> City of Sunny Isles Beach <br /> • 1eo7ocmnsAvenue <br /> 4.,''r o 00 � Sunny Isles Beach,FL 33160 <br /> c"'m i+' Telephone:(305)947-0606 Fax:1305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> I <br /> STATE OF FLORIDA ) <br /> COUNTY OF Miami-Dade ) <br /> I 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 /> 1 by an officer of the corporation. <br /> By: A David Carter, CCM <br /> Title: ' Senior Vice President <br /> IThe foregoing instrument was acknowledged before me this 18th day of <br /> April , 2012 , by David Carter, CCM [name <br /> Iof person], as Senior Vice President [type of authority], for <br /> Atkins North America, Inc. [name of party on behalf of whom instrument was <br /> executed]. <br /> IAFFIX NOTARY STAMP HERE: <br /> j vn Qi <br /> pR„ JULIA FORGIGNE Notary Public — State of Florida <br /> ;�,.•`fir Eys:;. <br /> �; Notary Public-Slate of Florida <br /> tf ,� _ My Comm.Expires Nov 4.2015 Julia Forgione <br /> I ., ,"' or Commission Y EE 137344 <br /> ® — nNalionalNDlary Assn. Print or Type Commissioned Name <br /> s, �, goad Through <br /> I Personally KnownOR Produced Identification <br /> Type of Identification Produced <br /> I <br /> I <br /> DE4VEER 23,2010 7 of 7 <br /> I0005027944.0512 Atkins I City of Sunny Isles Beach, RFQ No. 12-04-02 <br />