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• <br /> CITY OF SUNNY ISLES BEACH <br /> -SECTION -Six: CONTRACT FORMS <br /> :• ,.. <br /> • <br /> 00:3-s"Y"" <br /> • t :, 1 1= ANTI - KICKBACK <br /> • City of Sunny Isles Beach <br /> Y <br /> C. Y 18070 Coffins Avenue <br /> • s ', C Sunny Isles Beach,Fl 33160 <br /> •• <br /> o. so+ � Telephone:(305)947-0606 Fax(305)949-3113 <br /> • <br /> • ANTI-KICKBACK AFFIDAVIT <br /> • <br /> • <br /> STATE OF FLORIDA• <br /> ) <br /> • COUNTY OF Broward ) <br /> • <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 /> • <br /> By: A• <br /> - <br /> • Title: Vice President <br /> • <br /> • <br /> 4T{ie foregoing instrument was acknowledged before me this 50 day of <br /> • kl ( , by i-t TvmozyL [name <br /> • o person], as Is PC£Sr [type of authority], for <br /> • of, <br /> 4n.] & cry .4 [name of party on behalf of whom instrument was <br /> • executed]. <br /> • AFFIX NOTARY STAMP HERE: <br /> • <br /> • NuaalEMOCK N - State of Florida <br /> • 1,4. MY AflREaayPtEdcSWI�ONNetryEE 142118 <br /> 0 8°de13 2016 Hmzknt Pnnoc/C <br /> • Print or Type Commissioned Name <br /> • Personally Known V OR Produced Identification <br /> • Type of Identification Produced <br /> • <br /> • <br /> • a. ``'' <br /> •i^..._.. _ _:. :�]-1 FLORIDA'S 5:.s. KEITH and HL�,L FIRMNARS, A. <br /> RFQ)2-04-02 PAGE 57 �' <br />