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I <br /> - n ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> j-, 18070 Collins Avenue <br /> ��'D''•FLOP�O'4= Sunny Isles Beach,FL 33160 <br /> or'r or suN Fro Telephone:(305)947-0606 Fax:(305)949-3113 <br /> IANTI-KICKBACK AFFIDAVIT <br /> ISTATE OF FLORIDA ) <br /> ) <br /> ICOUNTY OF ) <br /> I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br /> I 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 /> 1i; <br /> 4/4 <br /> I Title: / <br /> Vice President/Secretar f reasurer <br /> I <br /> T e foregoing instrupient was acknowledged before me this 34-----day of <br /> , 20 )' , by Kristy Fuentes [name <br /> of pe 9�], as Vice President/secretary/Treasurer [type of authority], for <br /> DRC Emergency Services,LLC [name of party on behalf of whom instrument was <br /> executed]. <br /> I <br /> AFFIX NOTARY STAMP HERE: ��� --- <br /> Notary Public— State olfflorida <br /> IPrint or Type Commissioned Name <br /> IPersonally Known OR Produced Identification <br /> Type of Identification Produced <br /> I GARY A. DES ROCHES <br /> NOTARY PUBLIC <br /> State of Louisiana, Bar No. 19550 <br /> IMy Qommissiori is for life <br /> I <br /> 7 of 10 , <br /> I <br /> 121 <br />