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,Nnr 15, <br />y <br />1 <br />r <br />l ➢9 Q <br />yF C/ �. FIOR\ OS�Y <br />pN <br />r of sup+ <br />STATE OF FLORIDA ) <br />COUNTY OF 1►�tAMt bAt, ) <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: CUA+t+,l✓5 Gou2-&&C-Z <br />Title: (Le6t0l�JA 1- <br />The foregoing instrument was <br />�IA*J LAa , 2012—, by <br />of ,I,p rso a 'L��1O1�1 <br />executed . <br />AFFIX NOTARY STAMP HERE: <br />CAROAD BRI70 <br />Notary Public - State of Florida <br />��.•� My Comm. Expires Jun 21, 2013 <br />Commission # ,'EOM �, Bonded Through National Notary Assn. <br />cknowledged before ,me this <br />,Gear- es 60.4Lctlea. <br />Ve [type of <br />[name of party on behalf of whom <br />4 day of <br />[name <br />authority], for <br />instrument was <br />ry a of Florida <br />O 91bA-b i23&W rZ) <br />Print or Type Commissioned Name <br />Personally Known 0' OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 10 <br />