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<br />" <br />I'") <br />f) <br />1"') <br />') <br /> <br /> <br />ANTI-KICKBACK <br /> <br />') <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 />I') <br />t) <br />() <br />l) <br />(} <br />f) <br />') <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />COUNTY OF <br /> <br />) <br />) <br />) <br /> <br />STATE OF FLORIDA <br /> <br />:) <br />') <br />H <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 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 />A~ ffJ <br /> <br />o <br /> <br />By: <br /> <br />() <br />() <br />~ ) <br />() <br />\ ) <br />() <br />\ ) <br />) <br />) <br />) <br />~ <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br /> <br />Title: thvMJ <br /> <br />The foregoing <br />rGb ((/(>,11 <br />of person], as <br />(;(UJ)iV< hn/JIli.[t Ions <br />I <br />executed]. \\\"""" <br />",\ SCOTT III; <br />AFFIX NOTf1.tN-~~MP.W~.:"''''' <br />~~~ ...~ss'o,f~c ~ <br />$ CS....o~ ~.. 0 -:. <br />- ~ · Cl otA.9 ...,. ~ , <br />_ -:::.).. ~"l ~. y- <br />- .~ \- ').."'~ z- <br />- : ~....... en: = <br />:Q: : .. <br />~%.. I:>I..J v :oq:= <br />, ....-:: ..~ BL~ co. r'"';:: -- <br />, ~ .. ~u. 1;).... ... ~ ~ <br />~ ~'^ ....~RY 22. ~... (5'- ~ <br />"''l';- ......... \:).<<; ~ <br />......"1/ COUN\'<. "", <br />111"t"'\\'~// <br />Personally Known V OR Produced Identification <br />Type of Identification Produced <br /> <br />instrument was acknowledged before me this <br />20 I~ by .1)"1/1/1 I. Jni.sSer <br />, ---=--, YO"" VII-- <br />t)Wt1tr <br /> <br />day of <br />[name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />n <br /> <br />14 irk/I ['ottVtal/ <br />Notary Public - State of Florida <br /> <br />)/;r; ~l': ( /~r-cor--o-r <br />Print or Type Commissioned Name <br /> <br />I <br />J <br /> <br />DECEMBER 28,2010 <br /> <br />7 of 7 <br />