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O4 SJNNr +SC �� <br />' or sure " <br />STATE OF FLORIDA. ) <br />COUNTY OF ) <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 <br />commission, kickback, reward or gift, directly or indirectly by me or any member of my firm <br />by an officer of the corporation. ,N <br />By: <br />Title: <br />The foregoing instrument was acknowledg d before me this <br />20 Z, by <br />of person as Q [type of <br />�(1 5 [name of party on behalf of whom <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />"P,", Tammy Anderson <br />rp,�ppY P <br />COMMISSION #EE096997 <br />sue? EXP!RES: MAY 24, 2015 <br />'141101;,V Y". AARONNOTARY.cam <br />Personally Known <br />Type of Identification Produced <br />V <br />a <br />or <br />7 day of <br />[name <br />authority], for <br />instrument was <br />otary Pu is State of Florida <br />Ia Y's1 <br />n-) (I N-&V<Dn <br />Print or Type mmissioned Name <br />OR Produced Identification <br />DECEMBER 28, 2010 7 of 10 <br />