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t y0$NY IS,EJ <br /> ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> `•�•r1o� o�` Sunny Isles Beach,FL 33160 <br /> o. sus Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Mian: Dade ) <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 /> Title: Operations Manager <br /> The foregoing instrument was acknowledged before me this °l day of <br /> Y n cz L , 20 (CD , by k (� `3nee - [name <br /> of person], as Oi°0C 77Ot) S /1--bi OFA [type of authority], for <br /> (%Nr/ _ (172 S [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: -RS P ` <br /> Notary Public — State of Florida <br /> RICHARD a NZERIBE <br /> NOTARY <br /> — PUBLIC-- <br /> _.P�'. . STA <br /> tt TE OF FLORIDA <br /> '. <br /> Cam.FF920228 Print or Type Commissioned Name <br /> Expires 12/14/2019 <br /> Personally Known ' OR Produced Identification <br /> Type of Identification Produced <br /> DECOIBER 28,2010 7 of 7 <br />