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ANTI-KICKBACK <br />City of Sunny lsles Beach <br />18070 Colllns Avenue <br />Sunny lsles Beach, FL 33160 <br />Tslophone: (305) 947{606 Faxr (305) 949-3113 <br />ANTI-KICKBACK AFFIDAVIT <br />STATE OF FLORIDA <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: <br />Title: <br />The foregoing <br />December <br />instrument was acknowledged before me this | 3 a"v ot <br />20_!5...- by Kara Hoffman Bays [nameof personl, as President ltype of authority], for <br />HB Hoffman, LLC fname of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />Personallv Known OR Produced Identification <br />Type of Identification Produced <br />) <br />) <br />) <br />/^L^^r$t ,./v <br />- <br />Presideut <br />Notary Public - State of Florida <br />STEPMI{IE POLO <br />MY CoM tsstoN * GG 002356 <br />PolRESr July 20 A020 Print or Type'Commissioned Name <br />DECEMBER28,201O 7of10