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• VNN11, <br /> O�/� �f0 <br /> • f/ 0 ) ANTI - KICKBACK <br /> ® V1•\� t;' ! City of Sunny Isles Beach <br /> .� '.�`� 18070 Collins Avenue <br /> �,,,r'no'.`O4 J Sunny Isles Beach,Fl 33160 <br /> ® 'o. sus''' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • ANTI-KICKBACK AFFIDAVIT <br /> ® Afrer(„ 6rdl s/l <br /> ® STATE OF ftORTUA ) <br /> S COUNTY OF Mm4(ln6,43 ) <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 /> 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 /> ® By: ,/,_ I/ c' <br /> ® Title: (has-, f(nf <br /> The foregoing instrument was acknowledged before me this I& day of <br /> • Mkt , 20 RP , by 5r; A N...upna+ [name <br /> of person], as Pr-ec: , rnT [type of authority], for <br /> ® E1,,cfri1i Pc/L 1n5 ,Zinc dux p 4/k Mc [name of party on behalf of whom instrument was <br /> ® executefi]. <br /> ® AFFIX NOTARY STAMP HERE: - . . <br /> ® Notary Public '7 ' <br /> ® 2e-..L„ £lt€r ° <br /> ® Print or Tyjje Commissioned Name <br /> � , <br /> s. <br /> to Personally Known OR Produced Identification <br /> Type of Identification Produced N74 <br /> 0 <br /> DECEMBER 28,2010 7 of 10 <br />