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<br />c <br /> <br />c <br /> <br />c <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) 947-0606 Fax: (305) 949-3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />COUNTY OF .M~r~\.-Ocv~6 <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: <br /> <br /> <br />Mvr IUJ -n0J- <br /> <br />Title: <br /> <br />The foregoing instrument was jCknOWledged before me this JL day of <br />MO\ " , , 20-1L, by ~(' c1o.o/\ CJ:(y\'J [name <br />of pe'rson], as D;ClGt(){ 0{ U\ 'rre+:rt ~ [type of authority], for <br />f\ \\ C:.t '-I (Y\0\f\().~e,Mt'A\1 Cye{tJ~f,~ MI.. [name of party on behalf of whom instrument was <br />executedj. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />~~ <br /> <br />Notary Public - State of ~ri~4~ <br />~(J('i\ . G\ <br />S~,^J\v 'Md\ri<(\ <br />. <br />Print or Type Commissioned Name <br /> <br />@ <br /> <br />SHANE MARTIN <br />Commllllon #182..&.... <br />Notary Public - California <br />LOI Angel.. County <br />Comm. Expires NaY 25.2012 <br /> <br />Personally Known OR Produced Identification + <br />Type of Identification Produced ~. \J ,v, \ <br /> <br />DECEMBER 28, 2010 <br /> <br />? of? <br />