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SUN N Y IS< <br />F - <br />F <br />/ � I r <br />�Z <br />➢ ➢` <br />� <br />F. -� 0 <br />STATE OF FLORIDA ) <br />COUNTY OF pr6v) <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 myy firm or <br />by an officer of the corporation. n <br />la <br />Title: <br />The foregoing instrument was acknow edged before me this day of <br />�C , 20, by % [name <br />of person], as [type of authority], for <br />ffADCha 'h rOMk C 4fin [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />EEATIRIZ M, ARANGO <br />MY COMMISSION # DD764997 <br />ENPIRES March 04, 2012 <br />Print or Type Commissioned Name <br />Personally Known V OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 10 <br />