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NY y�F <br /> • <br /> =I ANTI - KICKBACK <br /> t' City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> 1F,,9''�F[OP`o0 Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF ) <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: J®-='.0 7 ez$VaitaS®i.A, <br /> Title: NolCe POle St®msw'T <br /> The foregoing instrument was acknowled ed before me this ' day of <br /> , 2017• by Jig e-s 6• 614 sol.'- [name <br /> of person], as I/i c-1Ict.E5 r n eirr- [type of authority], for <br /> .I721>A /f�G11A-moi C4-L 6)11+44c_nz[name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> "iy�. JOSE ANTONIO oivso No Public—State of Florida <br /> ,.[ 'Vs Commission#FF 083252~ � 1-0-4- c) <br /> � = Expires February 22,2018 o s C /-- A JBordud TM I Troy Fan!alumna 800.385-7019 <br /> Print or Type Commissioned Name <br /> ersonall _.Kno. • OR Produced Identification <br /> ype of Identification Produced <br /> DECEMBER 28.2010 7of 10 <br />