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• <br /> • <br /> • \`Jy^- ,SAF! <br /> :. :'ate. <br /> ® = , ANTI - KICKBACK <br /> VI- <br /> • \ `=/ City of Sunny Isles Beach <br /> ® / 18070 Collins Avenue <br /> ,i oxYSunny Isles Beach,FL 33160 <br /> ® o• �,. Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • ANTI-KICKBACK AFFIDAVIT <br /> • <br /> • <br /> • STATE OF FLORIDA ) <br /> • COUNTY OF Broward <br /> • <br /> • I, the undersigned, hereby duly sworn and deposed •ay hat no po 'en of this sum herein Bid <br /> ® will be paid to any employees of the City of Sun Isl:s Beach •• its ele -. officials as a <br /> commission, kickback, reward or gift, directly or in:irectly by mer :ni me I:r of my firm or <br /> • by an officer of the corporation. <br /> 11/ <br /> • gr <br /> By: <br /> • <br /> • Title: President/Owner <br /> • <br /> • The foregoing instrument was acknowledged before me this 30 day of <br /> • April , 2012 by Francisco Costoya, Jr. [name <br /> • of person], as President/Owner [type of authority], for <br /> • Frank Costoya Architect, P.A. [name of party on behalf of whom instrument was <br /> executed]. <br /> • <br /> • AFFIX NOTARY STAMP HERE: <br /> 11-c <br /> • SOTA.RT PUBLIC-STATE OF FLORIDA NotaryPublic — State of Florida <br /> Jay C. Evans <br /> • _Commission#DD795436 ( <br /> • <. /Expires: JULY 08,2012 <br /> BONDED TORO ATL4smC BONDING CO,LSC <br /> • Print or Type Commissioned Name <br /> • <br /> • Personally Known X OR Produced Identification <br /> • Type of Identification Produced <br /> • <br /> • <br /> • <br /> • <br /> • <br /> • <br /> I® OECEVEE928.2010 7 of 7 <br /> 60 <br /> • <br /> • <br />