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• <br />• <br />011 <br />S,NNY �S�f <br />s <br />cc suti <br />STATE OF FLORIDA ) <br />COUNTY OF��� °� !ZD ) <br />ANTI - KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947 -0606 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 />(y)"C.hct' CA Q, no <br />Title: y i (: �? P 2 s'i c�+ vi t <br />The foregoing instrument was acknowl dged before me this day of <br />C. C 1 <br />, 201, by ` fIC [name <br />of person], 1 as T, K-es'Ar-n-t- [type of authority], for <br />h r" j Lc Ec , mNr -ISe t��, pct [name of party on behalf of whom instrument was <br />executed]. + jc <br />AFFIX NgTWjA[#l!j1�,flERE0RID:`, <br />Jennifer Loomis <br />Commission #DD647426 No3jry Pu is -- -State of Florida <br />.,;''►?. Expires. MAR• 06, 2011 <br />BONDED THgU ATLpN is BONDING CO., INC. - -- <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />7 of 7 <br />