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? N is1Fs <br />ANTI - KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />y� p9t 4'.£'(yi�r ti ti <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />ANTI - KICKBACK AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF BROWARD ) <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 />By: <br />S(� <br />Title: Individual <br />T �joregoing instrument was .ack wedged before me this 2S day of <br />f� 1 20 i�s by i�s�1 [name <br />of person], as � [ty e of authority], for <br />[name of party on behg of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Notary Public — Stye of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 7 <br />