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vNNT s e <br /> 4.�.}N'U 1 <br /> ANTI — KICKBACK <br /> VI- -'1 n 12 <br /> A, ' .:_y I City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> e est''21(;.--2--- LCQt ss Sunny Isles Beach,FL 33160 <br /> ou'+' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF b1fet ) <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 . • -tuber of my firm or <br /> by an officer of the corporation. <br /> 41111101r <br /> / _IIiss..._ <br /> Title: d � _' _el <br /> y� The foregoing instrument w acknowledged before me this o2 3 day of <br /> /41-` - 20 !& by Mf-`A) /-/00VOZ [name <br /> of perton], as S1DoS\ - CEO [type of authority], for <br /> Act-\cc Ldb5z PMcftnetta (ISC [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: `'� <br /> ROCCO DPACIEU.o Nota/ Publcc. Sate of Florida <br /> . NOTARY PUBLIC <br /> -4,.';• -STATE OF FLORIDA 64 v ��\c-1..Lo <br /> a-•.-+; Coming FF041337 <br /> `7�1/�17 Print or Type Commissioned Name <br /> Personally Known " OR Produced Identification <br /> Type of Identification Produced <br /> • <br /> DECEMBER 28.2010 7 of 10 <br />