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yoMN L 1J <br /> �a%-, ANTI KICKBACK <br /> a=Vis, ' i City of Sunny Isles Beach <br /> •� /• 18070 Collins Avenue <br /> „io.' , Sunny Isles Beach.FL 33160 <br /> 4' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> P ANTI-KICKBACK AFFIDAVIT <br /> 10 <br /> • <br /> O STATE OF ILOR ) <br /> I ) <br /> COUNTY OFTovek (?j n ) <br /> • <br /> • I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br /> i will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br /> I commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br /> • <br /> I by an officer of the corporation. <br /> • <br /> By: C/zi C' <br /> • Title: ' oCD <br /> I <br /> • <br /> • <br /> The foregoing instrument was acknowledgede,<4 before me this day of <br /> ® M.> , 20 /6 , by e---,„ .e. /N..Le- [name <br /> • of person], as - V.e-s [type of authority], for <br /> J <br /> ® ...,, M_.,.y� -+ r. <br /> .- r . C. [name of party on behalf of whom instrument was <br /> • <br /> I executed]. <br /> I <br /> ® AFFIX NOTARY STAMP HERE:• 1 Q,� ,� <br /> • ry ublic - State of T a- ers <br /> • ate,saes <br /> I i,„ . a, <br /> My i 13 e-1-i4 C.-605 <br /> ® ��!;; y zs,2o1 <br /> • Print or Type Commissioned Name <br /> O \ ' <br /> ® Personally Known v OR Produced Identification <br /> • Type of Identification Produced <br /> • <br /> • <br /> I <br /> • <br /> I <br /> • <br /> • <br /> • <br /> • 00:04 2e,2010 7 of 7 <br /> • <br /> 0 <br />