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• <br /> • <br /> • <br /> `soea NY,t,,e <br /> j <br /> • .0-.= ANTI - KICKBACK <br /> • City of Sunny Isles Beach <br /> • < � 18070 Collins Avenue <br /> '. ,, <br /> .1• o0 o. Sunny Isles Beach.FL 33180 <br /> o <br /> • ,op,us'� Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • <br /> • ANTI-KICKBACK AFFIDAVIT <br /> • <br /> • <br /> • STATE OF FLORIDA ) <br /> •. ) <br />-• COUNTY OF �Q"� ) <br /> 0 <br /> • I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br /> O will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br /> O commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br /> O by an officer of the corporation. <br /> • <br /> • a. ' / <br /> 0 By: <br /> • <br /> O Title: /7P-6)--5/Z237)/7- <br /> O &3/Z297 TO <br /> O -T}V� <br /> • The foregoing instrument as acknowledge before me this day of <br /> ILTO l , 20 to , by 0 G. \ t o S [name <br /> of person], as 9ZG-ts764 T [type of authority], for <br /> , '3n-j4 u,,7 C,,,a0, [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: / Allo <br /> NOTARY PUBLIC-STATE OF FLORIDA ' • •ry Public — State of Florida <br /> Jessica Morales <br /> 1', Expire <br /> ..' s:icinNOV.22,2014 lss�o N t0 a s <br /> BaiEbTERcE1u'-,cBOYDNGCO.Dc. Print or Type Commissioned Name <br /> Personally Known ✓ OR Produced Identification <br /> Type of Identification Produced <br /> 08cu aaR28.2010 7 of 7 <br />