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<br />o <br /> <br />o <br /> <br />o <br /> <br />, <br /> <br />~ <br /> <br />SECTION 21 <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br />COUNTY OF ()R oW1+~o <br /> <br />) <br />) <br />) <br /> <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein bid will be paid <br />to any employees of the City of Sunny Isles Beach or its elected officials as a commission, kickback, <br />reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. <br /> <br /> <br />SIDENT <br /> <br />The foregoing instrument was acknowledged before me this }!nf day of Of. c.i: IY) (3 ,E~ <br /> <br />20.Df., by 0 A tJ 1/: L D. W L {. K L i Y [name of person], as <br /> <br />PI<.. f.. 5 I {) t Ni [type of authority], for \NEEKLEY ASPHALT PAVING, INC <br />[name of party on behalf of whom instrument was executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />~~ <br /> <br />Notary Public - State of Florida <br /> <br />- <br /> <br />N0T.', PY rr:a <br />,0' '''', LIC-STATEOFFWRIDA <br />f.:~,q'\ T~r~sa Patane <br />:....~/ CO~mlsslOn # DD680356 <br />"......' Exprres: JULY 16 2011 <br />BONDED TlflUT A'I"r ..~ , <br />....."'e BONDING co., ~Q, <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known <br /> <br />y... <br /> <br />OR Produced Identification <br /> <br />Type of Identification Produced <br /> <br />END OF SECTION <br /> <br />PAGE 82 OF 130 <br />BID No. 08-10-01 <br />