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t SuNNT,r4•1 <br /> ® ANTI - KICKBACK <br /> 1 ~ e <br /> City of Sunny Isles Beach <br /> c� 18070 Cons Avenue <br /> `r ....•rx oe., a•s Sunny Isles Beach,FL 33160 <br /> 'o.•u' Telephone:(305)947 0606 Fax (305)949-3113 <br /> ��/�c <br /> STATE OFFC)F�� ANTI-KICKBACK AFFIDAVIT <br /> ) <br /> COUNTY OF�V 1S ) <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 /> r <br /> By: "hi / AA, A 1Aa •. <br /> Tif : et ICAO IsEt I1! A •t it 4 <br /> ® egoing instrument was acknowledged before me this H I day of <br /> l tlr�� 20 �y it it _1/1 f!P [name <br /> of gerso as A`I, Or _1C1'JIY%hL Sl [type of authority], for <br /> a, r, Olisiti .1baaSrs. - [name of :.rty on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: •y, �,I ■ I I • "/ <br /> r .�°.',. SARA ELYSE GUTIERREZ j Notary Pub'WV of Florid: <br /> i Y- Notary Public,State of Texas i" <br /> � ;` MI Commission Expires , \%T _ (2/U,'�"'�Qe�eZ <br /> �' ,yY December 29, 2014 I. �i-'�. ^' <br /> Print or Type Commissioned Name <br /> Personally Known °rofi ce Identification <br /> Type of Identifc ion Produced .3 <br /> le <br /> DECENesi 28,2010 7 of 10 <br /> Hellas Construction, Inc. RFP#12-10-03 P.104 <br />