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SUNNY �S�F <br />FL00. os <br />T� Of SUN P <br />N <br />STATE OF FLORIDA ) <br />COUNTY OF MIAMI -0AV,-- ) <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 />of <br />Title: AMA, /r1A���� +��� ✓���MQ�� <br />ra <br />The foregoing instrument was acknpwledged before me this day of <br />J 20 1 by 6u 11 �\ �,�- � �rt.P�6�Q. [name <br />person], as [type of authority], for <br />[name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Personally Known <br />Type of Identification Oroduced <br />Notary Public — State of Florida <br />Ctv1 <br />Print or T e Comm ssioned Name <br />OR Produced Identification <br />DECEMBER 28, 2010 7 Of 7 <br />Y <br />Notary Public State of Florida <br />Cindy Capdevila <br />My commission DD877312 <br />Expires 06/19/2013 <br />Personally Known <br />Type of Identification Oroduced <br />Notary Public — State of Florida <br />Ctv1 <br />Print or T e Comm ssioned Name <br />OR Produced Identification <br />DECEMBER 28, 2010 7 Of 7 <br />