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r <br />F <br />L <br />1 <br />l_1 <br />l�l <br />Ot SVNNT fSl Ft <br />�n <br />L 'P <br />STATE OF FLORIDA <br />COUNTY OF Miami -Dade <br />ANTI - KICKBACK <br />City of Sunny Isles Beach <br />ISM 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 />The foregoing instrument <br />20 14 by <br />of pers0 ], as President <br />lI <br />By: <br />Title: Preside <br />was acknowledged before me this 3 / day of <br />Katryn O'Leary Richards [name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br />RY STAMP HERE: <br />yWmrurfry �l// <br />ptpYRA <br />iissq� N�Is, Notary Ptflbllic — State of Fltda <br />Aafi ygA lu vIve, <br />Print or Type Commissioned Name <br />STAiE OF�����• / <br />Personally K`n'STATE�� 1/ OR Produced Identification <br />Type of Identification Produced <br />1 <br />1 <br />executed]. <br />1 <br />AFFIX W <br />=o <br />1 <br />Q: <br />lI <br />By: <br />Title: Preside <br />was acknowledged before me this 3 / day of <br />Katryn O'Leary Richards [name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br />RY STAMP HERE: <br />yWmrurfry �l// <br />ptpYRA <br />iissq� N�Is, Notary Ptflbllic — State of Fltda <br />Aafi ygA lu vIve, <br />Print or Type Commissioned Name <br />STAiE OF�����• / <br />Personally K`n'STATE�� 1/ OR Produced Identification <br />Type of Identification Produced <br />1 <br />1 <br />1 <br />1 <br />DECEMBER 23.2010 <br />7 of 7 <br />M <br />