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<br />rl <br />~l <br />Fl <br />~ 1 <br />r 1 <br />r 1 <br />~ I <br />~ ] <br />I ~) <br /> <br /> <br />ANTI-KICKBACK <br /> <br />Of S\.l'" <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 />COUNTY OF Miami - Dade ) <br /> <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 /> <br />By: <br /> <br /> <br />Title: <br /> <br />r I <br />l J <br /> <br />, I <br /> <br />[name of party on <br /> <br />28 th day of <br />[name <br />[type of authority], for <br />behalf of whom instrument was <br /> <br />The foregoing instrument was acknowledged before me this <br />November 20 11 by Carlos Mallol, P,E., D,8,A <br />, -, <br />person], as Senior Vice President <br />CSA Central, Inc, <br /> <br />r I <br /> <br />of <br /> <br />executed] . <br /> <br />, , <br /> <br />, I <br /> <br />""""'" DINA K, RHYMES <br />"\I>-RY PUS'I" . <br />/,,0. ~/'0\ Notary Public - State of FlOrida <br />~.: A\l:.; My Comm, Expires Aug 16,2014 <br />~"'~. . ","'/ Commission # DO 986056 <br />"/~ oq.;,,,, <br />"~.9r,:,\,'" 80nded Through National Notary Assn, <br /> <br /> <br />l J <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />, J <br /> <br />Dina K. Rhymes <br />Print or Type Commissioned Name <br /> <br />, I <br /> <br />, J <br /> <br />Personally Known x OR Produced Identification <br />Type of Identification Produced <br /> <br />, J <br /> <br />, I <br /> <br />, I <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 7 <br />