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SiCnI � F�4S` 4NNY,ISLESz BEACH ;'® <br /> a <br /> SSEc'TT1®N Six: C®"NTRACT�4F® RMS s' 1'1q,,� is . t� �tps:: ,s� ar,'„', y v+ , asp 4 s siav`sm.s r+ ° ;, <br /> sr s,, °C:fi"mPo v �: .ikaka 5�nnfi: 4' l r,1 iltai«�u�.'�5.'� 4'P � ,::21 `LZ <br /> uNNY ,J�EJ <br /> % e= ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> ', 0, Or• 18070 Collins Avenue <br /> C'. ,ioa psi' Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax (305)949-3113 <br /> 0 <br /> ANTI—KICKBACK AFFIDAVIT r <br /> STATE OF FLORIDA ) <br /> COUNTY OF Broward ) <br /> 0 <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: a✓r a.®�_ <br /> Title: Vice President <br /> 0 <br /> r <br /> The foregoing instrument wa acknowledged be ore me this , day of <br /> (f , 20 by .i /0- X4'41 [name <br /> of person], , as fLa'az [type of authority], for <br /> lezi-rn am Sc, ro✓S [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> N tary Pub c — State of Florida <br /> a$it•*j: MARLENE PINNOCK � <br /> v: ,1 M FIRES:Febru aE13,2118 /912/ene f; lot c <br /> b` EXPIRES: tart'Poli 13,2018 TT11���C//L.!/ <br /> ''” 'Tin N'�"` c0ndtl"""° Print or Type Commissioned Name <br /> Personally Known Y OR Produced Identification <br /> Type of Identification Produced <br /> 0 <br /> 0 <br /> 0 <br /> s. <br /> sJ� 3 KEITH and SCHNARS,P.A. <br /> FLOR1DAS5l�.LOCAL FIRM <br /> PAC[ 44 RFQI2-04-02 <br />