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<br />. <br /> <br />. <br /> <br />. <br /> <br />SECTION 21 <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br /> <br />) <br />) <br />) <br /> <br />COUN1Y OF <br /> <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum <br />herein bid will be paid to any employees of the City of Sunny Isles Beach or its elected <br />officials as a commission, kickback, reward or gift, directly or indirectly by me or any <br />member of my firm or by an officer of the corporation. <br /> <br />By: <br /> <br /> <br />Title: <br /> <br />;-.., The foregoing <br />.ue c e - b-c"l. <br />[name of person], as <br /> <br />instrument was acknowledged before me this ~ day of <br />. r7 <br />, 2Jl.,Q~, by L.~ /Le f ':-4<:, -,/,L,1...., '20 I <br />r/.?i!~),~c/1 [type of authority], for <br />[name of party on behalf of whom instrument <br /> <br />was executed]. <br /> <br />AFRX NOTARY STAMP HERE: <br /> <br />+~- <br />NotaryPu61ic - State.o Florida <br />------- <br /> <br />N~~ PUBUKC-STATE OF FLORIDA <br />l '\ urt V. Ingram <br />\~_jCO~iOn # DD723885 <br />",.....#' ExpIreS: OCT. 19, 2011 <br />BONDEIl nIRU.^/,BONDING CO., INC. <br /> <br />Personally Known./ OR Produced Identification <br />Type of Identification Produced <br /> <br />Print or Type Commissioned Name <br /> <br />END OF SECTION <br /> <br />PAGE 91 OF 92 <br />BID No. 07-10-04 <br />