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<br />..11-5 (0roUf I LLC- d--16\a. ~ ~5e>iC- ~($ <br />K\= P No.: 11- b ~ - 0 \ <br />3~ <br /> <br /> <br />STATE OF FLORIDA <br />COUNTY OF ~&~ <br /> <br />ANTI-KICKBACK <br /> <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <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 /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />By: <br /> <br />~D~ ~IL<~~ <br /> <br />5,e-. JiCe- -=PAAS ~& \Q/t\ -r- <br /> <br />Title: <br /> <br />l~ day of <br />[name <br />[type of authority], for <br />behalf of whom instrument was <br />-.) <br /> <br />CONSUEl.O M. GARCIA <br />lA'f 00IUSS10N' 008777t1 <br />~....~ <br />~1f1lIu__~ <br /> <br />Personally Known / OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7of7 <br />