Laserfiche WebLink
'"" ANTI-KICKBACK <br /> VI- ,1 t <br /> City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> r�o••O•. Sunny Isles Beach,FL 33160 <br /> o. iot' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF ) <br /> I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid will <br /> 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 by <br /> an officer of the corporation. <br /> By: <br /> Title: President <br /> The foregoing instrument was acknowledged before me this — day of <br /> P1 , 20 /, by A✓de8 [name <br /> of person],} as ?per-. [type of authority], for <br /> b4A4teos atioix-;36,`( t-wS [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: /1, <br /> Notary Public - State ofd <br /> 'IC"1 dcrof,�. c <br /> /4jawl 44 IDG4.A 14. 1--On <br /> Print or Type Commissioned Name <br /> Co�h ,r, max/ S/Z/4 0i5 <br /> Personally Known ✓ OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER 28,2010 7 of 7 <br />