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ro_� n <br />hF C�y� •F L O P`pQ Sir <br />Fy OF SVN �N <br />STATE OF FLORIDA ) <br />COUNTY OF m <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 lected officials as a <br />commission, kickback, reward or gift, directly or indirectly ��rpae member of my firm or <br />by an officer of the corporation. 7j <br />The foregoing instrument was acknowledged before me this day of <br />- 20 by - - [name <br />of person], as u [type of authority], for <br />UU" G X \C.YViraMtPr 'r-- fr^iT-4,Atir(,, Wlffname of party on behalf of whom instrument was <br />executed]. <br />\\\\% � %IIIIII/I //, // <br />AFFIX NOTE W 4 E: <br />021171 , <br />� •. E ias�on � <br />0F F•LO\O�\\\� <br />s <br />No ary Public — ate 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 />