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<br />SECTION 21 <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />COUNTY OF ~Af:E ~ <br /> <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum <br />herein bid will be paid to any employees of the City of Sunny Isles Beach or its elected <br />officials as a commission, kickback, reward or gift, directly or indirectly by me or any <br />member of my firm or by an officer of the corporation. <br /> <br />By: <br /> <br />~~''{I\ ~k~( (j <br />-V t~~ ~ ~~Jf\\ <br /> <br />Title: <br /> <br />The foregoing instrument was <br />~e , 20'O~, by <br />[name of person], as <br /> <br />acl<n. ..owledged _before me this 17 {~day of <br />/d.;{j--{L( ~Q <br />[type of authority], for <br />[name of party on behalf of whom instrument <br /> <br />was executed]. <br /> <br /> <br />glllllflllflfllllll"""'"l111 <br />~ ANDRE'\IV"O'G'HIIIIIIlIIIIIIIlIIlJIIllflll'!: <br />S Nota p. 'NAN s <br />~ M ry Ubhc. State of Florida ~ <br />i CY Comm. Exp 11/28/2011 s <br />= ommls . = <br />"'IIIIlI"'Q"""I/I/I/I/""~~w'~,ff,,,!?/P737329 ~ <br />IlIolU"""IIIIIIIIIIIIII';; <br /> <br /> <br />I <br /> <br />AFAX NOTARY STAMP HERE: <br /> <br />Personally Known OR Produced Identification <br />e-ofldentification Produced <br /> <br />END OF SECTION <br /> <br />PAGE 77 OF 78 <br />