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Su014Y �S�R <br />ANT.I- KICKBACK <br />City of Sunny Isles Beach <br />�.D9 "• .r.. gyp, p 18070 Collins Avenue <br />Sunny, Isles Beach, FL 33160 <br />Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />ANTI - KICKBACK AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF ) <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 />By:. <br />Title: <br />The foregoing instrument was acknowledged before me this day of <br />UA `r' , 20--LL, by '-VA=Ae-L- Ly/ _ [name <br />of person], as � -t,AK3 &E T.-- [type of authority], for <br />_t Kta� C?c�► ��c-C „_ g—j�j C . [name of party on behalf of whom instrument was <br />executed]. <br />ueoweuumEBAUEUuurEuaMUOs . <br />AFFIX NOTARY STAMP HERE: a MA MI H" <br />,aN� "'nr 4 mm# D0717709 <br />�rxo11 e <br />Not C ri0a <br />near Man gaaNn4aptYw4 +ean of <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of .I en (cation Produced <br />DECEMBEa28,2010 7of10 : <br />y fit• �L� <br />