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<br />r-- <br /> <br />SECTION 21 <br />ANTI -KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY 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 />Title: <br /> <br />The foregoing instrument was acknowledged before me this <br />, 20_, by <br /> <br />day of <br /> <br />[name of person], as <br /> <br />[type of authority], for <br />[name of party on behalf of whom instrument <br /> <br />was executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Notary Public - State of Florida <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br /> <br />END OF SECTION <br /> <br />PAGE 91 OF 92 <br />BID No. 07-10-04 <br />