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r1 <br />I F 1 <br />r I <br /> <br /> <br />ANTI-KICKBACK <br /> <br />Of ~L1tl <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 />r 1 <br /> <br />ANTI - KICKBACK AFFIDAVIT <br /> <br />. , <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF Miami-Dade) <br /> <br />< , <br /> <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 />By: <br /> <br />Rudy M. Ortiz, P .E. <br /> <br />MffkJ <br /> <br />Title: <br /> <br />CEO <br /> <br />. , <br /> <br />. , <br /> <br />The foregoing instrument <br />May , 20~, by <br />of person], as (l ?j) <br />(}.i3; C P h oS lA..I+o. rds I I'f1U <br />executed]. <br /> <br />was acknowledged before me this day of <br />p tAd,! 1-1. l) r+-( 6- [name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />CHRISTINE L</d.iV -- Ii <br />~..w_., . -.", T g", <br />,of.':..*4tft, NOTMY Ji'U~Lle <br />"Y~i STATE OF FLORIDA <br />(i;/:;omm# DD0918218 <br />;,;.;::::;:::jt'>" Expires 9/12/2013 <br /> <br />C~~ <br />Notary Public - Stanen of Flo. tla <br /> <br />(! h v; s>A' Y) e.- 1--1 any c 1<- <br />Print or Type Commissioned Name <br /> <br />Personally Known V OR Produced Identification <br />Type of Identification Produced <br /> <br />City of Sunny Isles Beach Continuing Professional Architectural & Engineering Services RFQ 12-04-02 I 55 <br />