Laserfiche WebLink
<br />F I <br />l <br />~ ] <br />r 1 <br />r I <br />I ' I <br /> <br /> <br />I <br />J <br /> <br />Jl <br /> <br />. <br /> <br />: , I <br /> <br />I ~ j <br /> <br />f I <br /> <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 />STATE OF FLORIDA <br />COUNTY OF DADe_ <br /> <br />) <br />) <br />) <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 Beacb_o its elected officials as a <br />commission, kickback, reward or gift, directly or indirectly~byr;;e or an member of my firm or <br />by an officer of the corporation. <br /> <br />By: <br /> <br /> <br />Title: P <br /> <br />/ CEO <br /> <br />The foregoing instrument was acknowledged before me this ~ci day of <br />No\lFMkG-r , 20--11..., by Rafael L. Robayna [name <br />f' of person], as President/CEO [type of authority], for <br />. J Rohi'lyna ann Assor.; atp.R Tnr. [name of party on behalf of whom instrument was <br />executed]. <br /> <br />r I <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br /> <br />~v .(J~ Notary Public Stale of Florida <br />i...~" Jose Rives <br />~ c.'!, ; My Commission EE064080 <br />~ OFllO Expires 02113/2015 <br /> <br />Notary Public - State of Florida <br /> <br />J c~~ r--\. ~ I-Vr.;-c; 0lL <br />Print or Type Commissioned Name <br /> <br />Personally Known ''/... OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 7 <br />