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I ,•,---c ., <br /> VNNi is <br /> � ANTI - KICKBACK <br /> c • City of Sunny Isles Beach <br /> •, ? v 18070 Collins Avenue <br /> • ''•o* •. Sunny Isles Beach,FL 33160 <br /> 'o. iv.• ' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> IANTI-KICKBACK AFFIDAVIT <br /> I 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 /> Icommission, kickback, reward or gift, directly or indirectly my 1 el or any member of my firm or <br /> by an officer of the corporation. lip <br /> I fp- <br /> By: <br /> ITitle: Pr-silent <br /> I �hI//e',, foregoing instrument was acknowle_ dged before me this I day of <br /> (��^1 20, 12—, by �`�( c [name <br /> I of person], as �2�s [type of authority], for <br /> ` f1 [name of party on behalf of whom instrument was <br /> executed]. <br /> IN <br /> AFFIX NOTARY STAMP HERE: J �- <br /> ' UtfvTANA Notary Public— tate of Florida <br /> W ArDnASQo.a oosolso2 ^ L <br /> My CO. 1oN 30.2012 („�U`nl'�^� <br /> ' ' &F7 Viv Dnoous Msa_Ca <br /> 18xyiNO1AR1' <br /> Print or Type Commissioned Name <br /> IPersonally Known OR Produced Identification <br /> Type of Identification Produced <br /> II <br /> 1 <br /> I <br /> IDECEMBER 26,2010 7 of 7 <br />