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SUNNY ISt <br />c 19F <br />ti <br />.0 '0r 4�,r <br />C'rr <br />OF SUN FNO <br />STATE OF FLORIDA ) <br />COUNTY 01`&)a),AVb ) <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 portio of this sum herein Bid <br />will be paid to any employees of the City of Sunny Isles Beach or is elected officials as a <br />commission, kickback, reward or gift, directly or indirectly by me,�r y member of my firm or <br />by an officer of the corporation. A ,, 7� <br />0 <br />Title: <br />The foregoing instrument was ac <br />ed before me this q41 day of <br />of person], / as 1—ke S1 cleA_L-J:::� / <br />L U _n L1gA1 &3 iCAj2'/ a ,[name of party on <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />LAURA GUTIERREZ <br />;.. .- MY COMMISSION # DD 819615 <br />;., ! -T EXPIRES: September 3, 2012 <br />"` Bonded Thru Notary Public Underwriters <br />Z D /C) [name <br />_ [type of authority], for <br />behalf of whom instrument was <br />Notary Public — State of Florid <br />k0u elf ) aAie-Ue_z__ <br />Print or Type Commissioned Name <br />Personally Known Y OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 10 <br />1 <br />