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I J Bonfill 8 Associates <br /> RFQ#12-04-02 Page 122 <br /> II <br /> =� `dr ! ANTI - KICKBACK <br /> , <br /> • t �• City of Sunny Isles Beach <br /> \,o,. 16070 CnRns Avenue' r�oj„� <br /> Sunny!skis Beach,FL 33160 <br /> ''w so•' Telephone:(305)947-0606 Fax:(305)949.3113 <br /> I <br /> ANTI-KICKBACK AFFIDAVIT <br /> ISTATE OF FLORIDA ) <br /> ) <br /> I <br /> COUNTY OFMI4MI - DST>a <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 /> t / <br /> By: acc4� BONFit_L <br /> 1 Title: PR esitekST <br /> TheII • foregoing instrument was acknowledged bef,preme this cion' day of <br /> ��/ J / 20) 1 by JRCG)NP_.1/reef�OiJ�-i//bee_ [name <br /> 01: ersop],], as r�. - * [type of authority], for <br /> II J• n¢l Jf tv-d .. IO S,.Tf,X; [name of party on behalf of whom instrument was <br /> executed]. ` <br /> I - AFFIX NOTARY STAMP HERE: 0�' / ///�' / <br /> 7 <br /> ' Notary Public— State of Florida <br /> a'...... CATHERINE A.SMITH 1 / �L /1 <br /> 4 e t'- Notary Public•Stale Cl Florida 1 LC?-/ 1 en ,_ /1 g/ _�n�1 <br /> c • <br /> •• <br /> My Comm.Expires Jan 24,2015 I '1 /!K /-r <br /> ?dot Commission if EE 57675 I Print or Type Commissioned Name <br /> Personally Known X OR Produced Identification <br /> I <br /> Type of Identification Produced <br /> I . <br /> I . <br /> Decode£&28.2010 7 d 7 <br /> I • <br />