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F1 <br /> c��' ' -\ ANTI - KICKBACK <br /> ' V- • :. <br /> ;a _ S <br /> • im ,J. City of Sunny Isles Beach <br /> 16070 Collins Avenue <br /> ". '• i owra Sunny Isles Beach,FL 33160 <br /> ' •o. .v. ^ Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> I STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF BROWARD ) <br /> II, the undersigned, hereby duly sworn and deposed sa th. no portion of to'. m herein Bid <br /> will be paid to any employees of the City of Sun .each or ._ elected officials as a <br /> 1 commission, kickback, reward or gift, directly or in P - any member of my firm or <br /> by an officer of the corporation.I <br /> �� <br /> By: SII <br />' Title: President <br /> ITFC,_foregoing instrument wa - •,-• -dged before me this I day of <br /> I 20� v by [name <br /> I of person], as r [type of authority], for <br /> (o - [name of party on behalf of whom instrument was <br /> ' executed]. <br /> AFFIX NOTARY STAMP HERE: 0 <br /> I 0 <br /> INotary Public — State of Florida <br /> W AN�.�tssio"NpD°all /J��J <br /> A we COPI4Es:314 <br /> (1)04a_ tUl/Lf <br /> `0E o 2012 <br /> Co. °1n. <br /> 18..;.tQ1�Q, <br /> Print or Type Commissioned Name <br /> IPersonally Known OR Produced Identification <br /> Type of Identification Produced <br /> I <br /> I <br /> I <br /> DECFMRFR 28.2010 7 of 7 <br />