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ii <br />u _ x <br />k � <br />t k. <br />0 ryk »_1 pf- <br />OF ;UN -I.NU <br />STATE OF FLORIDA ) <br />COUNTY OFjft h 14 <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 />Title: <br />foregoing instrument was acknowledged bef re me this day of <br />20 by [name <br />as i` &A [type of authority], for <br />-ccee K. [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Notary Pub Ic — State of Flori a <br />P int or, ype_Co_mrnDiss&ed game <br />Personally Known OR Produced I entific ton <br />Type of Identification Produced <br />DECEMBER 28, 2810 7 of 7 <br />ar n� <br />�` <br />Notary Public State of Florida <br />; <br />Osvaldo Duran <br />My Commission EE012243 <br />ca <br />Expires 0712712014 <br />OF t <br />Notary Pub Ic — State of Flori a <br />P int or, ype_Co_mrnDiss&ed game <br />Personally Known OR Produced I entific ton <br />Type of Identification Produced <br />DECEMBER 28, 2810 7 of 7 <br />