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<br />SECTION 21 <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br /> <br />COUNTY OF <br /> <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein proposed will be paid to <br />any employees of the City of Sunny Isles Beach or its elected officials as a commission, kickback, reward or gift, <br />directly or indirectly by me or any member of my firm or by an officer of the corporation. <br /> <br />By: <br /> <br />Title: <br /> <br />The foregoing instrument was acknowledged before me this _ day of <br />[name of person], as <br />[name of party on behalf of whom instrument was <br /> <br />,20_, by <br /> <br />[type of authority], for <br />executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Notary Public - State of Florida <br /> <br />Print or Type Commissioned Name <br /> <br />o Personally Known <br />o Produced Identification <br /> <br />OR <br />Type of Identification Produced <br /> <br />END OF SECTION <br /> <br />78 <br />