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,,){4NY/S Fr <br /> 0e� ANTI - KICKBACK <br /> _ City of Sunny Isles Beach <br /> • t- 18070 Collins Avenue <br /> 3F'D91•F Loas� ', Sunny Isles Beach,FL 33160 <br /> c r'or sus Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> TeX as <br /> STATE OF FL-61:1M ) <br /> f :� ) <br /> COUNTY OFWI I <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: C <br /> The foregoing ins ent wacknowledge <br /> sir as acknowled • bef•r- me this 401' dayof <br /> 9 9, 201 , by IV • L <br /> [name <br /> of ,�,Pa sbn], as - [type of authority], for <br /> �G thfrr e f"IS riG [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: •0')J /� <br /> Nota lic.— S •to of-Florida <br /> • TIFFANY WILKES <br /> qI--Fifa f�I �Ifr.s <br /> My Notary ID#123933814 I <br /> Expires January 27,2022 Print or Type Comissioned Name <br /> Personally Known V OR Produced Identification <br /> Type of Identification Produced <br /> S <br /> 7 of 10 <br />