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<br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />() <br />. <br />. <br />. <br />. <br />. <br />,....,. <br /> <br /> <br />ANTI-KICKBACK <br /> <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-1J606 Fax: (305) 949-3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br />COUNTY OF Q"LM ~ <br /> <br />) <br />) <br />) <br /> <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 /> <br />By,-- )c.cdr.}l.y - r au SL--(L- <br />Title: V\ltCLvu:t0'~ ~ J/wef/" <br />\ c::' ~~ <br />D day of <br />[name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />l^~he foregoing instrument was acknowledged before me this <br />r'f\(l.Q.,\ , 20.1L-, by <br />of person], as <br /> <br />executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />/;}-:;".\:r~~. JASON A. WESTFOAT <br />g.: :.~ MY COMMISSION. DD 992109 1 <br />.;~.... EXPIRES: June 13, 2014 <br />"~iif. Bonded Thru Notary Public UnderwritelS ~ <br />Print or Type Commissioned Name <br /> <br /> <br />Personally Known ~R Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />70f7 <br /> <br />22 <br />