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4 ,t4 H Yry � S;.`°.r` <br />of , <br />V� ilI <br />.1 rf• <br />tiF 7'.i l.o <br />Suri <br />STATE OF FLORIDA <br />COUNTY OF Miatni-Dade <br />ANTI -KICKBACK <br />City of Sunny isles Beach <br />8070 Collins Avenue <br />Sunni lsles Beach, FL 33,160 <br />Telaphcne; (305) 947-0608 Fax (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <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 />The foregoing <br />,tl= <br />of11 erson], as _ <br />x`911 'e -I f/V o � fl) <br />executed]" <br />B;91)() <br />Title: <br />instrument was acknowledg <br />20/yz, by . Z 1%/Q Li <br />AFFIX NOTARY STAMP HERE: <br />E <br />otary Public State of Florida <br />tantey Moose <br />ly Commission EE 631961 <br />xp+res49128120i6 <br />t� <br />before me this day of <br />% [name <br />[name of party on <br />_ [type of authority], for <br />behalf of whom instrument was <br />Naotary Public —State of Florida <br />Print or Type C missioned Nrt <br />Personally Knoivn _ OR Produced Ide7fic,ation <br />Type of Identification Producedt/ <br />DECEMBER 26, 2010 7 of 7 <br />