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<br />". <br />:.1 .\~ <br /> <br />, <br /> <br /> <br />ANTI-KICKBACK <br /> <br />City of Sunny Islss Beach <br />18070 CoIUItS Avenue <br />SuMY 1.1" Beach, FL 33180 <br />Telophooo: (306) 94700'08 Fax: (305) .,..3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br /> <br />COUNTYOF &5~./n,IV/'it;lJ'1'l-" ,-~de- <br /> <br />I, 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 corporatlon. <br /> <br />6l By: <br /> <br />/+1-- 'f>b~~~1 <br /><-...J <br /> <br />"" Title: <br /> <br />,\"..".,' d,. <br /> <br />l <br />, <br /> <br />of <br /> <br /> <br />instrument <br />201&x by <br /> <br />was <br /> <br />me thIs rJ.. b day of <br />[name <br />[type of authority], for <br />[name of party on behalf of whom Instrument was <br /> <br /> <br />as <br />rlC, <br /> <br />executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Public - Sta <br /> <br />A /&iff? <br />/ I or Type Commissioned Name <br /> <br /> <br />Personally Known L- OR Produced Identification <br />Type of Identification Produced <br /> <br /> <br /> <br />- _.~-'::.fit. <br />BAAA"t.I ~\lill\lt '. <br />fI vWlM\SSlON'OO.~~" '.; <br />I ~.... M <<vp'''CS: tAa1 9. ,0 . '.' <br />l.l : ~ U""I"- Pd'C(jc~Wf\"'" ~ ~ <br />M . n-Aad"thlIlMol" .___,;;,,:0:." <br />~. , D'H" """'~ <br />" <br /> <br />DeceMaER28, 2010 <br /> <br />7017 <br /> <br />~~ ~i. ~~ ;:) <br />