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I CITY OF SUNNY ISLES BEACH <br /> SECTION SIX: CONTRACT FORMS <br /> • son.,,ste <br /> • t o> = ANTI - KICKBACK <br /> • City of Sunny Isles Beach <br /> ® 18070 Collins Avenue <br /> r <br /> * '• to.‘",,, Sunny Isles Beach,FL 33160 <br /> • <br /> . <br /> Telephone:(305)9.17-0606 Fax:(305)949-3113 <br /> • <br /> • ANTI-KICKBACK AFFIDAVIT <br /> • <br /> • STATE OF FLORIDA <br /> • <br /> • COUNTY OF Broward ) <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 /> • // <br /> • By: a4c,( C/. 4a-- <br /> • <br /> • Title: Vice President <br /> • <br /> • The foregoing instrument wasp acknovyledged before me this 3() day of <br /> • 740121 20 )2 , by h/,jChQ6i L I5 [name <br /> • of person], as JI P i )en {' [type of authority], for <br /> , fh oOc/ 5 ,(6 [name of party on behalf of whom instrument was <br /> • <br /> • executed]. <br /> • AFFIX NOTARY STAMP HERE: .� q <br /> • *rMs il.7n- <br /> N• • ry Pu • 1c — State of Florida <br /> 3 r WRWES:February <br /> ry 13,2 1 l�n otK <br /> .'t, 8atleE Thu Nafay Pt 13UHpiMe� <br /> • Print or Type Commissioned Name <br /> • <br /> ® Personally Known OR Produced Identification <br /> • Type of Identification Produced <br /> • <br /> • <br /> • <br /> • <br /> ® . . _- J EiHK, Ig• <br /> A <br /> FtoR,OAs Ki1ocMFIRM <br /> • RFQ12-04-02 PAGE 69 _1 <br />