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0 <br /> ® %0'MNY tr�F <br /> ANTI - KICKBACK <br /> ® = City of Sunny Isles Beach <br /> 18070 Cdfins Avenue <br /> • Sunny Isles Beach,FL 33160 <br /> 'o. ro+ Telephone(305)947-0606 Fax:(305)949-3113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> 0 <br /> • STATE OF FLORIDA <br /> O ) <br /> ® COUNTY OF 1D � <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 indirect) by me or any member of my firm or <br /> b0y an officer of the corporation. <br /> f <br /> • <br /> 0 <br /> By: <br /> ® P ,r <br /> Title: r _ . <br /> • <br /> ® The foregoing instrument was acknowledged before me this day of <br /> 20 12 , by Daphne I.Gurri Matute [name <br /> 0 of person], as President [type of authority], for <br /> O Gurri Matute PA [name of party on behalf of whom instrument was <br /> • executed]. r <br /> O AFFIX O_ .S • <br /> � Q <br /> Na�Y <br /> Public.Mato of Float® Myr, a***Jul 29 Notary Public - State of Florida <br /> tI, coos*" a lowsst <br /> Eit_er,f p Mbv-cnb <br />® • Print or Type Commissioned Name <br /> O / <br />® Personally Known OR Produced Identification ✓ <br /> 0 Type of Identification Produced FA-L., <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> O DECEMBER 28.2010 7 of 7 <br />® GURRI MATUTE PA/ RFC+ NO. 12-04-02/ PAGE 46 <br /> 0 <br />