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• <br /> `ye$NY 04(FJ <br /> 0 'atm= ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> • 18070 Coffins Avenue <br /> '•• °'• r i ot�eo Sunny Isles Beach,FL 33160 <br /> or ,us 't Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Miami -'bacle) <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 : or any member of my firm or <br /> by an officer of the corporation. <br /> By: <br /> Title: 71 ' 4) . <br /> f The foregoing instrument was acknowledged before me this I Q/41 day of <br /> wst , 20 , by Ate_x l apeL [name <br /> of pe n], as Pre 5; eh+ [type of authority], for <br /> Fu.n C' "tk-s\ , t(AO [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> QJEANNINzsctnitRRY tary Public — State of Florida <br /> . ►tvmwMISvDNIFF9019e5 <br /> S•\r.00 D0'tR :May tkrao f 6-hn; ne 1 <br /> Print or Type Commissioned Name <br /> Personally Known /\ OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER M.2010 7 of 7 <br />