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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 ) <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 />Title: <br /> <br />The foregoing instrument was acknowledged before me this day of <br />, 20_, by [name <br />of person], as [type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />executed] . <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Notary Public - State of Florida <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 7 <br />