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SvNNY ,s�6 <br />10 <br />r, <br />/",A _ rT <br />(� ) <br />COUNTY E)F <br />) <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 />By: ON <br />Title: (-If � L�:) <br />The foregoing instrument was acknowledged before me this g +1� <br />day of <br />`bec�Lk r- , 20�, by A431)P_0&) NAQRM- N [name <br />of person], as O [type of authority], for <br />_ mtN TeRFL T I f P [name of party on behalf of whom instrument was <br />executed]. n <br />AFFIX NOTARY STAMP HERE: <br />Karen Garam Shin <br />Barrister & Solicitor <br />LOGOS LAW OFFICE <br />4392 Halifax Street <br />Burnaby, BC V5C 3X5 <br />T.(604)294 -0101 F.(604)294.6777 <br />otary Public — State of Flarift TP�J (N <br />g�c -ctS�l Co�uM811�. <br />& zaj C W-Pdv1 sk_l I N <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced 3C DRWEWS ucc-NGE i`v� • 3� �530� <br />DECEMBER 28, 2010 7 of 7 <br />