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S JNNY If,F <br /> <l= ANTI - KICKBACK <br /> � City of Sunny Isles Beach <br /> _ 1818070 Coffins Avenue <br /> �� s <br /> s'+.<<e�` a. Sunny Isles Beath,FL 33160 <br /> es' o. sMr'° Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> GEORGIA <br /> STATE OF PL-614441;A <br /> COUNTY OF Forsyth <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 : ected officials as a <br /> commission, kickback, reward or gift, directly or indirectly by me .r any ember of my firm or <br /> by an officer of the corporation. <br /> /. <br /> By: X/ /' <br /> Title: President <br /> The foregoing instrument was acknowledged before me this 4th day of <br /> August , 20 15 , by Kevin McCann [name <br /> of person], as President [type of authority], for <br /> American Facility Services Inc. [name of party on behalf of whom instrument was <br /> executed]. <br /> • <br /> AFFIX NOTARY STAMP HERE: <br /> Emilie A Blankenship Not Public — tatiof`-IF: ' _ = Georgia <br /> Notary Public <br /> State of Georgia <br /> Cherokee County Emilie A Blankenship <br /> My ComExpire <br /> 10/8/2017 or yp <br /> Print Type Commissioned Name <br /> 1 <br /> Personally Known V OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER 28,2010 7 of 10 <br />