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11 <br /> 01/47,4;:..--n-:'.. ANTI - KICKBACK <br /> (( � .r ' <br /> •i • .. i. : City of Sunny Isles Beach <br /> N.:7:��;1�,�,_ ,� 18070 Collins Avenue <br /> ie ';•oio`'°a4 Sunny Isles Beach,FL 33160 <br /> o, soy ' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF -NOWC.Yr/, ) <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: wh h 1V ‘.,.__ \-, <br /> Title: Rr-esi8-eicl- <br /> The foregoing instrument was acknowledged before me this / I day of <br /> Rol , 20 lIn , by C hrisi-,r,�, PdPrinn/Lrn [name <br /> of person], as TC1'esidPb.A- [type of authority], for <br /> k4n,p Clrour ,,++rrwLo*IlI CO(InJOP, [name of party on behalf of whom instrument was <br /> executed]. . <br /> AFFIX NOTARY STAMP HERE: <br /> ittsaida... fit Hent(--6 <br /> 1 ,.,^"....... PAMELA L.JAMES ) Notary Public State of Florida <br /> o. Notary Public - Stale of Florida o <br /> l 1: I°' <br /> +_� •_My Comm.Expires Aug 17,2017 <br /> , ...:..E,,,-8•E'0ar Commissions FF 013809 <br /> Bonded Through National Notary Assn. ) Print or Type Commissioned Name <br /> Personally Known OR Produced Identification (— <br /> Type of Identification Produced -FIorcla- driV?r's I ;[rrse, <br /> DECEMBER 28,2010 7 of 10 <br />