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ANTI - KICKBACK <br />f <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />yFCD' . ,L04 oQS� Sunny Isles Beach, FL 33160 <br />0 5 „ +s Pa 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 />O 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 />4) <br />} Title: ` <br />The foregoing instrument was a no ledged/ bef r this`d day of <br />t) z2 , 20 /�, by cei` .`0A) /� - � � l� 7 � [name <br />f pers ], as [type of authority], for <br />[name of party on behalf of whom instrument was <br />�) executed]. Z—) <br />AFFIX NOTARY STAMP HERE: <br />} 2���.R••P.B�ip MADAY ESTER GARCIA <br />MY COMMISSION # EE 0%5AM 59 Not b 'c — tate f Florida <br />* * <br />EXPIRES: March 2, 2015 <br />e Bonded TW Budget Notary Services <br />P 'nt o Tvoe Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 10 <br />