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I004 NI,, <br /> � <br /> . <br /> �'� <br /> I ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> 18070 Couins Avenue <br /> Sunny Isles Beach,FL 33160 <br /> ITelephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> I <br /> PC44f,J _F4 '1"- <br /> STATE OF FLORIDA ) <br /> COUNTY OF / /z- ) <br /> II, 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 /> I 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 /> / c--MRa,r mn.' <br /> ITitle: Vim 1gEnt0 > ,.-0y2„u t ( e,-> <br /> I The foregoing instrument was acknowledged before me this 1—Pk- <br /> - day of <br /> al,9MPFR , 20/'1 , by MASK A v(11;1sf-{-TM4-il [name <br /> of person], as VP OF MA^JA4cM i OPEztnlo,J [type of authority], for <br /> TKO 6,2..A-SC t C� [name of party on behalf of whom instrument was <br /> executed]. <br /> IAFFIX NOTARY STAMP HERE: ^ <br /> IS 1(]� <br /> �Q�11 LY c <br /> I OOMMONWEALTHalSeal PENNSYLVANIA otary Public — t�fFlor of-Florida- i1 VA►JI, <br /> Nctarlal Sea( <br /> kindle Mimes,Notary Public . <br /> Oty of Pittsburgh,Allegheny County )Anl E u F VI. d tWE S <br /> I fey Commission Aug.2'� <br /> mow.P 1VANIAASSOma,aNOrw� Print orType <br /> Commissioned Name <br /> IPersonally Known X OR Produced Identification <br /> Type of Identification Produced <br /> I <br /> I <br /> I <br /> I DECEMBER 28,2010 7 of 10 <br /> ProGrass RFP No.12-10-03 129 <br />