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<br />1 <br />1 <br />, I <br /> <br /> <br />1 STATE OF FLORIDA ) <br />I ) <br />COUNTY OF Palm Beach ) <br /> <br />ANTI-KICKBACK <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 />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 />The foregoing instrument <br />December , 20~, by <br />of person], as President <br />Craig A. Smith & Associates, Inc. <br />executed] . <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />A./'VVvvy, <br /> <br />'5.~9.Y Pt.J. <br />.f tl-~<1,l' Notary Public State of Florida <br />.,..!I< . Amanda J Kidwell <br /> <br />~ ~ .'. i/ ~y Commission 00853842 <br />.I "~o~ ,,0 Expires 01/25/2013 <br /> <br />~"""""~.A""""',;"""" <br /> <br />By: <br /> <br />{}f:w <br /> <br /> <br />President <br /> <br /><' <br /> <br />Title: <br /> <br />was acknowledged before me this 2nd <br />Gene R. Schriner, P.E. <br /> <br />[name of party on <br /> <br />day of <br />[name <br />[type of authority], for <br />behalf of whom instrument was <br /> <br /> <br /> <br />Amanda J. Kidwell <br />Print or Type Commissioned Name <br /> <br />Personally Known X OR Produced Identification <br />Type of Identification Produced <br /> <br />Proposer: Craig A. Smith & Associates <br /> <br />RFQ No. 11-11-02 <br /> <br />80 <br />