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<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 />) <br />COUNTY OF Pasco ) <br /> <br />1/ 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 />Title: Ty <br /> <br />[name of party on <br /> <br />day of <br />[name <br />[type of authority], for <br />behalf of whom instrument was <br /> <br />8th <br /> <br />The foregoing instrument was acknowledged before me this <br />August / 20~, by Tyler Lillibridge <br />of person], as vice President <br />Cross Construction Services, Inc. <br /> <br />executed] . <br /> <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />\"'~ S <br />i" ""......t.,... TAMARAJAME <br />H.:'fJ\t!'i..~ Commission # DO 985611 <br />G ';~;... .~E Expli"es August 24,2014 <br />Ii ,.'!.'-/;,. ^<;,,- ~"nedThruTroyFainl"'"""""~7019 <br />/!, ..I{'J"'~~ '"N' <br />Ii '''''''' <br />.'-=-~ <br /> <br />Tamara Janes <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 10 <br />