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y�NN>•rs1Ei <br /> ANT] - KICKBACK <br /> City of Sunny Isles Beach <br /> 18070 cams Avenue <br /> 'r rao <br /> 93°I. Sunny 1st Beach.Fl 33160 <br /> r••or.a '� Tehp11n1e.(305)917-0806 Fax(305)919-3113 <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: <br /> Title: <br /> The foregoing instrument was acknowledged before me this day of <br /> , 20 , by [name <br /> of person], as _ [type of authority], for <br /> [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> Notary Public — State of Florida <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> DCO.aR2a7010 7of7 <br />