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of ci T F O e3'' <br />STATE OF FLORIDA ) <br />COUNTY OF BROWARD ) <br />ANTI - KICKBACK <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 />ANTI - KICKBACK AFFIDAVIT <br />I, the undersigned, hereby duly sworn and deposed s that no portion of this -sum herein Bid <br />will be paid to any employees of the City of Sun Isl s Bje ch �` i elected officials as a <br />commission, kickback, reward or gift, directly or i it ny member of my firm or <br />by an officer of the corporation. <br />By: <br />Title: I <br />The ,fpregoing instrument was ackno,4 <br />20 (/1--, by <br />of person], as � <br />[name of, <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />dual <br />ore me this :j, day of <br />— [name <br />[type of authority], for <br />on behal of whom instrument was <br />P <br />WANDA QUINTANA rotary Public — State of Florida <br />J� <br />® MY COMMISSION # DD801302 <br />EXPIRES: July 30, 2012 <br />I -800.3- NOTARY Fl. Notary Discount Assoc. Co <br />,...f.�P Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />I ` J DECEMBER 28, 2010 7 Of 7 <br />