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SJ"NY IS4E <br />n ANTI - KICKBACK <br />J u $ <br />' City of Sunny Isles Beach <br />18070 Collins Avenue <br />yF iy9' • F L0"'o~ y�r Sunny Isles Beach, FL 33160 <br />c' o. SUN Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />ANTI - KICKBACK AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF orange ) <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: Vice President <br />The foregoing instrument was acknowledge4 before me this day of <br />, 20 /Z , by S1 [name <br />of (/person j, as e Pre [type of authority], for <br />[name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />- Notary Public — State of Florida <br />HARRIET H. STORMS <br />MY COMMISSION EE 180075 <br />� <br />EXPIRES: June 8, 2016 c} <br />pF Bonded Thru Notary Public Underwriters <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 />