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STATE OF FLORIDA ) <br />COUNTY OF ) <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 />,The foregoing <br />of personl as <br />. Isar <br />executedT <br />Title <br />instruM-ent was <br />20 _ 1, by, <br />AFFIX NOTARY STAMP HERE: <br />;i ; o�PayPb%% ZANNEISHA MOR 7Florida <br />`� Notary Public -State <br />=ro�o c commission FF My Comm. Expires Oc <br />re me this <br />[type of <br />[name of party on behalf of whom <br />day of <br />[name <br />authority], for <br />instrument was <br />No Public — State of Florida <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced PT ;1 � ��t:)jI- /13 <br />7of7 <br />