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1 SONNY the <br /> O -.-nv- <br /> ANTI - KICKBACK <br /> 5 _ •l1 _ <br /> • �,. V : City of Sunny Isles Beach <br /> .9.,–. <br /> _ e 18070 Comas Avenue <br /> 4 <br /> . 9Y •7t0oo ,,• Beach,Sunny Isles Bea .FL 33160 <br /> e"'o..0+ '10Telephone:(305)997-0606 Fax(305)999-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF Broward ) <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 /> • <br /> By: Jason R. Wf L. I :�» <br /> Title: President, <br /> The foregoing instrument was acknowledged before me this 23rd day of <br /> August , 20 16 by Jason R. Wells [name <br /> of person], as President [type of authority], for <br /> Jacey Investments, L.L.C. d/b/a Elite Tent Company[name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: /J%2 <br /> _ , jJ <br /> Notary Publliicq— Sttatteofof,Florida <br /> /;,:a4... <;. LETICIA ROMAN <br /> MY COMMISSION 1t FF244407 n <br /> .i.:::.'4,1 .. EXPIRES June 25,2019 �� l G gory-Ice-7 II«� a=1 Fbiallouryasrq.aom Print or Type Commissioned Name <br /> Personally Known V OR Produced Identification <br /> Type of Identification Produced <br /> o[cENeai 213,2010 7 017 <br />