Laserfiche WebLink
I <br /> ,e')-Pi----NY • <br /> �!�! <br /> �'r., ANTI - KICKBACK <br /> �.. <br /> %.,• City of Sunny Isles Beach <br /> _ 18070 Collin Avenue <br /> `o. <br /> r r o• .a Sunny Wes Beads,FL 33160 <br /> o..r, ' Telephone:(305)947-0606 Faz:(305)449-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF 6rpu7& ) <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 /> c <br /> By: \ . <br /> Title: Vice- PreSr i e.-Cf" <br /> gg foregoing instrument was acknowledged before me this /7 day of <br /> QG> b P , 20 / ' , by [name <br /> of person], as Vice_ P_resitlf [type of authority], for <br /> Tile 1'e./ br±tem,Sr5-ic.,^r.r y, [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> • <br /> el N ,EKfORAYALA No • •• •u• is— State of Florida <br /> _, * M CQ,4ylsslctl t FT 6103 <br /> . :`m- - EXPIRES:Ociobet 3,2418 }r J , / <br /> ,„, Q� Balti4Rd7AFIP4C ySoft �1°/.77CS')r �� / <br /> Print or Type Commisfoned Name <br /> Personally Known OR Produced Id ratification v <br /> Type of Identification Produced F L , 1)L- • . <br /> CECE6t9£a 28,2010 7 of 7 <br /> S 1 B <br />