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• <br /> • ? �t <br /> • -�_ ANTI - KICKBACK <br /> • `Z' City of Sunny Isles Beach <br /> 15070 Collins Avenue <br /> • <_ :rrc.1oag' Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • <br /> • ANTI-KICKBACK AFFIDAVIT <br /> • <br /> • <br /> • STATE OF FLORIDA ) <br /> • COUNTY OF Palm Beach ) <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: jar <br /> e Ingram, P.E. <br /> • Title: Senior Vice President/Principal Associate <br /> • <br /> • <br /> • The foregoing instrument was acknowledged before me this 30th day of <br /> • April , 20 12 , by Jerry Ingram. P.E. [name <br /> of person], as Senior Vice President/PrincipalAssociate [type of authority], for <br /> • Kimley-Hom andAssodates,Inc. [name of party on behalf of whom instrument was <br /> • executed]. <br /> • <br /> • AFFIX NOTARY STAMP HERE: �f <br /> /ca,n b -eCu2�rrf <br /> • NotaryPublic — State of Florida <br /> • ;��?" TAMMY L SCARLOTI <br /> MY COMMISSION 0 EE161705 i w�YJ 1/ Z S�r/V t <br /> • • EXPIRES January 19,2016 Print or Type Commissioned Name <br /> • f4G7)3o.01ro ( \Aettern <br /> • <br /> • Personally Known x OR Produced Identification <br /> • Type of Identification Produced <br /> • <br /> 0 <br /> • <br /> 0 <br /> • <br /> • <br /> • DECEMBER 25,2010 7 of 7 <br /> • <br />