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l I <br /> 4Su$I N Y i.s,,.� <br /> /•� ANTI -KICKBACK <br /> 9 <br /> G. <br /> _ + :•_�;; City of Sunny Isles Beach <br /> ti �' 18070 Collins Avenue <br /> '',,99,,, ‘° 5'' Sunny Isles Beach,FL 33160 <br /> fI c.''''o,SUN'1c Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF ) <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: �"b J< J LC!� <br /> 1 <br /> Title: 4„4u G�-�-,-t. <br /> The foregoing instrument was acknowledged before me this day of <br /> , 20 , by [name i <br /> of person], as [type of authority], for <br /> [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> Notary Public—State of Florida <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> 1 <br /> DECEMBER 28.2010 7 of 7 <br />