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O�SVNNY rs<Ffd <br />ANTI - KICKBACK <br />• City of Sunny Isles Beach <br />���' ^ »?•« 16070 Collins Avenue <br />se''➢�, FLO yw' Sunny Isles Beach, Fl 33160 <br />or &v„ ►a° Telephone: (305) 947.0606 Fax: (305) 949 -3113 <br />ANTI- KICKBACK AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF Palm Beac) <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 />Charles Gusmano <br />Title: Member / Manager <br />31st <br />The foregoing instrument was acknowledged before me this day of <br />• January 20_11--, by Charles Gusmano [name <br />of person], as Member / Manager [type of authority], for <br />Southern waste systems LLC [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />rotr3;:;�e,t KATHLEEN A. SASS <br />* * MY COWISSION # DD 667213 <br />EXPIRES: June 22, 2011 <br />41, �\or Boom ThN W Notify somm <br />xxx <br />Notary Public — State of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />• DECEMBER 28, 2010 7 of 7 <br />