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yJNNY <br /> ANTI - KICKBACK <br /> V • •'1`_.. Z <br /> • <br /> ® City of Sunny Isles Beach <br /> =a.•• - 18070 Collins Avenue <br /> •COS' ` Sunny Isles Beach,FL 33160 <br /> or sus Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Miami Dade ) <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: Vice President <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 /> JOSEFINA M FERNANDEZ <br /> '' <br /> .p. -ta /Public — State of Florida <br /> MY COMMISSION#FF228438 ! / <br /> EXPIRES May 07.2019 / <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> 411 <br /> 7 of 7 <br />