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SUNNY IS, <br />s <br />OF B� <br />a � <br />~ n <br />O r <br />yf i99' : F l o?. R <br />c�TY or VN 00 <br />STATE OF FLORIDA ) <br />COUNTY OF ) <br />ANTI -KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <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: "imf_lel <br />Title: 9-0e— <br />The foregoing instrument was acknowledged before me this day of <br />AV :3— , 20 ICI , by hanvr_ M • lL&'OW -PIr [name <br />of Verson],as (Ylr_tm�n nom, ,jr�-Xinr2- ' ' [type of authority], for <br />J4 [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Notary Public — Sta of Florida <br />ad vt- PU1o(?,IR_(3- <br />Print <br />c;.Print or Ty�e Commissioned Name <br />t✓� <br />Personally Known OR Produced Identification <br />Type of Identification Produced iZ L QS(p 7G�'�-0 <br />DECEMBER 28, 2010 <br />:o1�xY'Pu'•.. <br />^ <br />?W Q <br />EVELYN SOLORZANO <br />Notary Public State of Florida <br />Commission p GG 288836 <br />? a �!°'�• <br />My comm. Expires Jan 6, 2023 <br />Notary Public — Sta of Florida <br />ad vt- PU1o(?,IR_(3- <br />Print <br />c;.Print or Ty�e Commissioned Name <br />t✓� <br />Personally Known OR Produced Identification <br />Type of Identification Produced iZ L QS(p 7G�'�-0 <br />DECEMBER 28, 2010 <br />