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) <br />) <br />) <br />_J <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <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 />Of SU'" <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF Palm Beach ) <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 />f~v~ <br /> <br />Title: Department Manager, West Palm Beach, Florida <br /> <br />The foregoing instrument wf1 acknowledged. before me this ~f) day of <br />kit \. !. 2012-, by --l11l-V- L~).,t()f\"A''<~U [name <br />of~ ,person], as Cf).~~f:L1"\.\- rf\(}~<< 0 [type of authority], for <br />~'\O(\\-Pc1 000~r c.J:-tDr,tS [name f party on behalf of whom instrument was <br />executed] . <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br /> <br />.' :A' <br />Notary Public - tate Florida <br /> <br />~ L_.' 8: ('- ~ <br />lX\r I GlD- ' ,X 11J'\ d ) <br />Print or Type Commissio d Name <br /> <br />"~ltW',,, PATRlClAA. GRINGERI <br />$'4."'J ~~ MYCOMMISSION#EE111658 <br />.:~} EXPIRES: Augusl25, 2015, <br />" II:~ Bonded Thru NoIafy Public Und,erwrilers <br /> <br />Personally Known /' OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 7 <br />