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I <br /> ti'M�- F <br /> 1 1o' .*''` ANTI - KICKBACK <br /> o` <br /> • _ City of Sunny Isles Beach <br /> I �' 18070 Collins Avenue <br /> se '•,LO‘' *.'� Sunny Isles Beach,FL 33160 <br /> c''o. ,o� '~� Telephone:(305)947-0606 Fax:(305)949-3113 <br /> IANTI-KICKBACK AFFIDAVIT <br /> ISTATE OF FLORIDA ) <br /> COUNTY OF Orange ) <br /> 1 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 /> Icommission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br /> by an officer of the corporation. <br /> IBy: . 4 f- C� \c,_y <br /> ITitle: Shareholder <br /> 1 The foregoing instrument was acknowlOg?�l d �efor me this � day of <br /> ,Y,∎ , 20 I , by n)Pi( J V I t- [name <br /> I .o^ 'of person], _ as w► .* ■_ .' [type of authority], for <br /> i. I ._ .A <br /> i' 1 ►�J. i / name of party on behalf of whom instrument was <br /> executed]. <br /> IAFFIX NOTARY STAMP HERE: • / <br /> `..i v. f4 4 IAA <br /> IlNotary P c f tate of F rida Notary Public State of Florida <br /> My CornrrxlSlission FF 213651 Tiffany S. Wynn <br /> %.,../ Expires 04/05/2019 <br /> IPrint or Type Commissioned Name <br /> I Personally Known OR Produced Identification <br /> Type of Identification roduced <br /> I <br /> 1 <br /> II <br /> DECExsER 28,20:0 7 Of 7 <br /> I - SiB <br />