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I") <br />I J <br /> <br />") <br /> <br />, <br />i <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 />) <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />) <br />) <br />) <br />) <br />) <br />). <br />) <br />) <br />) <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF Miami-Dade ) <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 />~ A(t- <br /> <br />\ <br />I J <br /> <br />Title: <br /> <br />Vice-President <br /> <br />} <br /> <br />x., The foregoing instn../ment ~as. ac~nowl d ~9 before me this <br />!1 ~f\ \ , 20~, ~y v - _"'f'\ <br />of person], as \J; ~ .... ~'{tc7\ <br />Ar-~o..1\'(~ )\ C1 A4A)Ci q rfc) j,(I[' [name of party on <br />executed] . <br /> <br />day of <br />[name <br />[type of authority], for <br />behalf of whom instrument was <br /> <br />}~ <br /> <br />"c~~~v. ~~8(0 MARTA M. CAPOTE <br />*..~ * MY COMMISSION # DD 881097 <br /><P~" EXPIRES: May 7,2013 <br />~r"omc~c Bonded Thru Budget Notary Setvices <br /> <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Nota Public - State of FI <br /> <br />vY\ar~ m. (q ~ <br />Print or Type Commissioned Name <br /> <br />Personally Known J( OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMBER 28.2010 <br /> <br />7 of 7 <br />