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04 SJNNY ,S(�'I` <br />V ��Z <br />� o <br />Ty OF 5uN ';'N <br />STATE OF FLORIDA ) <br />COUNTY OF Dade ) <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 />Title: <br />Theme foregoing -0— instrument was acknowledged before me this ) 3- da of <br />20! l , by � n t•y W ' (i Y <br />of person], as a-- !ze._IDE ) G— [name <br />. 9 �,�,U �-�-� � , Ck D [ [type of authority], for <br />executed]. name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />Notary Public — ate of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />ARY CEAVERS <br />* *_" MY COMMISSION H EE 040309 <br />Bond EXPIRES: March 5, 2015 <br />hru Notary Public Underwriters <br />DECEMBER 28, 2010 7 of 10 <br />