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<br />o <br /> <br />SECTION 21 <br />ANTI.KICKBACK AFFIDAVIT <br /> <br />STATEOFFEOOIC'A AL~ <br /> <br />COUNTY OF a+ I~-e.--' <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: D <br /> <br />The foregoing instrument was acknowledged before me this _ day of . 20_. by <br />\. J.fxr~ YV. 1QYDok.-S [name of person], as ( f"u <br />[type of a ority] , for-rftr ~~(1tll''J SvU. J lY\v [name of party on behalf of whom instrument was <br />executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />~~ ~Cv..c ~ <br />Notary Public - State of ~ A-L.- <br /> <br />.=:fp r (6L ~~e.t/L<€- Co-v t:-r <br />Print or Type Commissioned Name <br /> <br />o <br /> <br />~erSOnallY Known ~ <br />[] Produced Identification <br /> <br />OR <br />Type of Identification Produced <br /> <br />END OF SECTION <br /> <br />o <br /> <br />78 <br />