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SVNMY 1,,F <br /> '_ ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> 18070 Cain Avenue <br /> '�`•r to''Y ..' Sunny Isles Beach.FL 33160 <br /> ''o. ,uv' Telephone:(305)947-0606 Far(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF orD1v 4 ) <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: \C-4?-2 <br /> ,7a. <br /> Title: V(CC { re5%den+ <br /> 0 zit foregoing instrument was acknowledged before me this / y day of <br /> G P V , 20 / b , by [name <br /> of person], as Vire_ Presirled, f [type of authority], for <br /> The_l'e/n lvratim,Strte Tie, [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> Y.:.----- <br /> ,P::tet JEKTORAYALA No • • •u . is— State of Florida <br /> , ,-„ MYCOASOSSICNrfF911313 <br /> `1 - EXPIRES:Oct:09,3,2019 Z:9—fel.--40( 4 c <br /> %pm,' Bu101011n kipONON SenFe Y'q <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Id ratification V <br /> Type of Identification Produced F` . I)L- <br /> CECE,mEa 28,2010 7 of 7 <br />