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23. Anti-Kickback Form
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23. Anti-Kickback Form
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ANTI -KICKBACK AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF%^ ) <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: )I Ip, � <br />The foregoing instrument was a knowledged before me this day of <br />20 by ( efi �� ": �-r r�4,::; M10 .�, [name <br />a i� ��I��t 4 i j'trh Na. j a�p <br />[type of authority], for <br />of person , as ��i 1- a �� � � 9T r� , <br />[name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />dt�YP4� <br />"I' DIANA MARIA FERRARA <br />4 <br />Notary Public -State of Florida <br />Commission # HH 210965 <br />My Commission Expires <br />December 26, 2025 <br />Notary Public — State of Florida <br />_ '_ n, <br />1 C <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification% - <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />ANTI -KICKBACK <br />kh <br />City of Sunny Isles Beach <br />Fr <br />p <br />18070 Collins Avenue <br />a x oR yw <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />ANTI -KICKBACK AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF%^ ) <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: )I Ip, � <br />The foregoing instrument was a knowledged before me this day of <br />20 by ( efi �� ": �-r r�4,::; M10 .�, [name <br />a i� ��I��t 4 i j'trh Na. j a�p <br />[type of authority], for <br />of person , as ��i 1- a �� � � 9T r� , <br />[name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />dt�YP4� <br />"I' DIANA MARIA FERRARA <br />4 <br />Notary Public -State of Florida <br />Commission # HH 210965 <br />My Commission Expires <br />December 26, 2025 <br />Notary Public — State of Florida <br />_ '_ n, <br />1 C <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification% - <br />Type of Identification Produced <br />DECEMBER 28, 2010 <br />
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