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I <br /> SVN NY is,F <br /> f <br /> =� e ANTI - KICKBACK <br />. r n <br /> Z <br /> • '_-5.-;;;; City of Sunny Isles Beach <br /> ' ?' `.-- 18070 Collins Avenue <br /> �• D',.r pa`°o; Sunny Isles Beach,FL 33160 <br /> o. ,uM'� Telephone:(305)947-0606 Fax:(305)949-3113 <br /> 1 ANTI-KICKBACK AFFIDAVIT <br /> ISTATE OF FLORIDA ) <br /> ) <br /> 1 COUNTY 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 /> 11 4a. . <br /> By: / / <br /> I / <br /> Title: Vice President/SecretaryITreasurer <br /> I <br /> T e foregoing instru ent was acknowledged before me this gX�day of <br /> , 20 1f, by Kristy Fuentes [name <br /> 1 of pe .• ], as Vice President/Secretary/Treasurer [type of authority], for <br /> DRC Emerge cy Services,LLC [name of party on behalf of whom instrument was <br /> executed]. <br /> IAFFIX NOTARY STAMP HERE: __--- <br /> INotary Public— State ojFIorida <br /> IPrint or Type Commissioned Name <br /> • <br /> IIPersonally Known OR Produced Identification <br /> Type of Identification Produced <br /> I • <br /> CARY A. DES ROCHES <br /> NOTARY PUBLIC <br /> State of Louisiana, Bar No. 19550 <br /> , MyrCommission=is for life <br /> 7 01 10 . <br /> I 121 • <br />