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4 ILv The <br /> . <br /> D��- .±ef <br /> ANTI - KICKBACK <br /> V 11 Z <br /> City of Sunny Isles Beach <br /> 18070 Ca01ns Avenue <br /> `. '',•,i o l`or Sunny Isles Beach.FL 33160 <br /> 0, ,u* 'Yo�. Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF 6ROWARb ) <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 /> By: <br /> Title: KA A-+.1 PSe2 <br /> I ,, The foregoing instrument was acknowledced before me this 20�`" <br /> day of <br /> `i urck_ , 20� by TIo3ee'n t k.1OK�` [name <br /> of person], ason&QPM_ [type of authority], for <br /> ZMeoc tibi C.;/no 6-0 Souk [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: / / <br /> i�7rf. CHELDA Commission Rn <br /> MFF OG187856 ENE� <br /> Notary Public— Stat- of Florida <br /> .4 My Commission Expire; ///��� <br /> Decem•ber 14, 2018, n,kiAok Xpi1goaeit <br /> _. Print���/ IIIIorr////Tyyp(e CommissionedrYrlName <br /> Personally Known OR,Produced Identification 1`" <br /> Type of Identification Produced I pl UerR beet)Se_ <br /> DECEN5Ea 28.20,0 7 of 7 <br />