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<br /> <br />ANTI-KICKBACK <br /> <br />Or iUt>I <br /> <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 /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br /> <br />COUN1Y OF ~-a"iUrJV f1;;'p11"-~,j e- <br /> <br />l, the undersigned, here~ dUI~ 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 /> <br />d--- Title: <br /> <br />A-~ \3>bY~'~' <br />'\',~\& ~ <br /> <br />~ By: <br /> <br />The ~ regoing instrument was acknowle ed befo~ me this c2 b day of <br />, C1t , 20~ by df-e 3orc;j(JI'~ [name <br />of p,ers ], as (VIe- <?'(/t~ [type of authority], for <br />.;foe- / f/L c , [name of party on behalf of whom instrument was <br />executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />~UbIiC - State of Florida <br />.j; ra/Yl ;fb cJ; av <br />Int or Type Commissioned Name <br /> <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br /> <br /> <br />~~ ~~~~~~7"}!."~~~ <br />""'" B"IiAAM />'\3\~\P.. '... .. <br />~""~!r.;.rY;f/"~ v r,OMM\SS\ON j~ ~D }.a:1t, ':, <br />.~~~f;- M J . Madl ?,r,,' :'. <br />a>: :.~ EXPIRES: P'{bii~ li>~,", ,. .: <br />~~" .:t"f Bonded !hfU NO\~..._..;.;;.:::,,;;.'. <br />......''t,Rf,:~'...... ~----=::.-~l,;tIWPr~~:-..,a. <br /> <br />DECEMBER 28, 2010 <br /> <br />70f7 <br />