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STATE OF FLORIDA ) <br />COUNTY OFR I AHI <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: _A <br />�9-Yy1 <br />Title: �J l GL - �reS ( C)o <br />The foregoing instrument was acknowledged before me this �_ day of <br />:;1jZn 20�, by 6r� 222 d [name <br />of person], as i`C� [type of authority], for <br />tt7AT HoeTlt� me of party on behalf of whom instrument was <br />executed]. V-0c <br />AFFIX NOTARY STAMP HERE: <br />r'i:aya <br />DAVID TOWN <br />Notary Public - State of Florida <br />�= My Comm. Expires Jan 18, 2018 <br />•„ ���..��, Commission # EE 181173 <br />Notary Public — State of Florida <br />Print or Type Commissioned Name <br />Personally Known AA__ OR Produced Identification <br />Type of Identification Produced fl, ,CG P,5/31`627 <br />DECEMBER 28, 2010 7 of 10 <br />