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) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />I ) <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 />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF VA- 'D 0 ) <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 />~~~ <br /> <br />Title: Pres ident <br /> <br />The foregoing instrument was arknowledged before me this.30 day of <br />it-pnL , 20~, by QIQ:CI... yY). (IA-A /lie ~ [name <br />of person], as Pre S I cI...e.t't 1- [type of authority], for <br />(0 u )( h ~ -j- 120 / ~ 6 [name of party on behalf of whom instrument was <br />executed] . <br /> <br /> <br />~a\. <br />,'l) <br /> <br />Notary Public S... at Florida <br />Zenaida Fernandez <br />My Commission,iE 157804, <br />Expires 01/1712d"l6 <br /> <br />4':~-~of~,~a <br /> <br />::{ 13. IV.4-1 0 4 ~N 1-r't QA ? <br />Print or Type Commissioned Name <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Personally Known x OR Produced Identification <br />Type of Identification Produced tV I r1- <br />{ <br /> <br />DECEMBER 28,2010 <br /> <br />7 of 7 <br />