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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 person], as _ <br />executed]. <br />instrument <br />20 1" , by <br />elOb <br />AFFIX NOTARY STAMP HERE: <br />E�f,� <br />Notary P=7- <br />0 <br />Albe.t of <br />My ComExpires <br />Title: eq <br />was acknowledge before me this day of <br />die. t f 1 ZZ-C.A 1` [name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br />�X'kp- <br />kaiary <br />Public — State o � lorida�) <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identific ion <br />Type of Identification Produced ED .2 - - r) L - <br />7of7 <br />