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Su NNY )gt <br />a <br />C„ 6 ab <br />STATE OF FLORIDA ) <br />COUNTY OF Miami -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 Beac r its elected officials as a <br />commission, kickback, reward or gift, directly or indirectly ,by or any member of my firm or <br />by an officer of the corporation. <br />The foregoing <br />December , <br />of person], as _ <br />Williams Paving—, <br />executed]. <br />2 <br />Title: Vice P <br />instrument was acknowledged before me this 14th day of <br />2011 , by Alan B. Rodriquez [name <br />Vice President [type of authority], for <br />D . , Inc. [name of party on behalf of whom instrument was <br />AFFIX NOTARY STAMP HERE: <br />NOTARY PLBLIC- STATE OF FLORIDA <br />Lourdes M. Vega <br />Coma fission # EE026036 <br />'• ' Expires: lcaorP.1 co0INC <br />BONDED T14RU ATLANI <br />Notary Public — State of Florida <br />Lourdes M Vega <br />Print or Type Commissioned Name <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 10 <br />