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SUNNY rS�F <br />a, F <br />R <br />SF j P `O <br />C(Tt OF SUN RN4 <br />STATE OF FLORIDA ) <br />COUNTY OF DA Dt ) <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 />Title: <br />She foregoing instrument was acknowledged before me this I day of <br />'S�vve_ , 20 Q_, by CV,y- is hG r\ 1-c [name <br />of person], as \)i, cam_ ?r-c -5 1 ClLe P,�--f [type of authority], for <br />S" irl c c-- S 0 ___E_ <br />_ r\ [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />`,=o�Y p�' •� Maria Lourdes Toman <br />- COMMISSION # EE 117961 <br />EXPIRES; AUG. 01, 2015 <br />;; - www kmmNOTARY.com <br />Notary PublicY State of Florida <br />NPLP�- WJr AS ^pm <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br />DECEMBER 28, 2010 7 of 10 <br />