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i <br />i <br />i <br />i <br />�,yYSrox r�� <br />� F <br />!.f Y�1Cy <br />U Ps <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 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 />Title: Individual <br />The foregoing instrument was acknc(wledged before me this day of <br />20� by _( Cs� � [name <br />of pers n , as [type of authority], for <br />[name of a on b alf of whom inst t <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Fvv� <br />o M ss io XPIRES: July 30, 2012 „ FL NotaryDiscowtAssce.C�. <br />F rty I rumen was <br />Notary PuWc — St_te 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 />