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• • <br /> NN, , <br /> Q�1Fr <br /> ANTI - KICKBACK <br /> is City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> �io•`O' Sunny Isles Beach,FL 33160 <br /> o. ,u Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA <br /> COUNTY OF A4;An4;- 4c, ) <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 /> : <br /> BY <br /> Title: T f e c- 1 t6 <br /> The foregoing instrument was acknowledged before me this 1 day of <br /> \ obel , 20tb , by e.'Jld 1a \loaono. [name <br /> of personas �:ce A-oc [type of authority], for <br /> c Ever* Coif) [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> Notary Public — State of Florida <br /> PATRICIA M ALMA S \ \ <br /> e, MY OMMISSION#FFISS942 ' 't�l..�\� fes. 4cciNe\Ck.a, <br /> EXPIRES:FEB OS,2019 <br /> o„" Banded through 1stS[ate Print or Type Commissioned Name <br /> • Personally Known ✓ OR Produced Identification <br /> Type of Identification Produced <br /> DECEMBER 29.2010 7 of 7 <br />