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O� SuNNY is <br />V Z <br />S; y97 <br />o? <br />_.. � <br />P . FL S <br />Cary Qs $UN ��O <br />STATE OF FLORIDA ) <br />COUNTY OF "e ) <br />ANTI - KICKBACK <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 />ANTI - KICKBACK AFFIDAVIT <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 />The foregoing <br />of person fl, as <br />�rIJ/ <br />executed]. <br />By:O�IM� 7Uc�s- <br />,, - /12C4s <br />Title: <br />instrument was acknowl <br />20 / I , by. <br />this <br />PlYS19-16 -Ir [type of <br />S, =A-C • [name of party on behalf of whom <br />AFFIX NOTARY STAMP HERE: <br />0'"al Seal <br />ANN FLUHARTY <br />Nmary Public. stale of FWi& <br />My (',=ft Expires 31OW2014 <br />No. DD 966190 <br />"z5r— day of <br />[name <br />authority], for <br />instrument was <br />Notary Public — State of Florida <br />Print or Type Commissioned Na e <br />Personally Known I _ OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 7 <br />