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0 <br /> • <br /> c,‘ <br /> e ANTI - KICKBACK <br /> Ste:' <br /> City of Sunny Isles Beach <br /> 18070 GOGrtS RKnu! <br /> 4. Sunny Sury Isles Beach,Fl. 33160 <br /> Telephone:(305)947-0606 Fa.:1305)949-3113 <br /> O ANTI-KICKBACK AFFIDAVIT <br /> ® STATE OF FLORIDA <br /> ® COUNTY OF Dade <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 offidals 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 /> ® Qdo Q.Lt <br /> ® By: <br /> ® Title: President <br /> tb <br /> ® - ThQ foregoing instrument was acknowledged b fore me this 27 day of <br /> ® 20 IL, by A-ioA nn. is [name <br /> of person], as iCa 4 ctai\j- [type of authority], for <br /> 0 an..r-RS -r Q,baerc [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> u • 4. r <br /> ® N•rf Ty Public— State of Florid <br /> Noon Pudic d Pudic s Roma • <br /> Y Zee F8111e110e2 L eft Gt*cSc- <br /> .n f-Z�(Y� .t _P/L <br /> 0 Pains <br /> QE 157804 <br /> ° c..1 F.sn0111712015 Print or Type Commissioned Name <br /> Personally Known x OR Produced Identification <br /> Type of Identification Produced r7 a- <br /> 0 <br /> 0 <br /> 0 <br /> O occa4sEn 7e,4019 7 of 7 <br /> 0 <br /> 0 <br /> 0 <br /> ® Curtis ± Rogers Design Studio RFQ 12-04-02 53 <br /> O <br />