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Q�4�N NY IS�� <br />�m <br />� a <br />SFr T• f_l OR OS. <br />Ty or SYN �A <br />STATE OF FLORIDA ) <br />COUNTY OF DADE ) <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone. (305) 9470606 Fax: (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <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: <br />Title: President 2 <br />The foregoing instrument was acknowledged before me this 01 'qday of <br />A►�. -M 20_CL, by Ct- ev [name <br />of person], as qV-E-�s } jC�, [type )of authority], for <br />L -P_ 42 �z-;E .SIC C 4_�P [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />NINI J UAREZ <br />My COMMISSION # FF958965 <br />` EXPIRES Apr11 14. 2020 <br />�4or;�sa•as naw.r+oca •� <br />Personally Known <br />Type of Identification Produced <br />`1 <br />Rotary Publ•c — Statof Florida <br />Print or Type Commissioned Name <br />OR Produced Identification <br />DECEMBER 28, 2010 7 of 10 <br />