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<br /> <br />ANTI-KICKBACK <br /> <br />OF SU" <br /> <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach. FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ll..-t l <br />COUNTY OF .'h A ) <br /> <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 /> <br />1f/fY' <br />~~)rlJt/Y' <br /> <br />Title: <br /> <br />The foregoing instrument was acknowledged before me this day of <br />, 20_, by [name <br />of person], as [type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />executed]. <br /> <br />t. II I.. III II. ~~.: ~ all II... c..,...............I~ <br />i """,,/A SERVAT : <br /> <br />! _'\\\11I1> Comm# 000880302 i <br />. . <br />. " Explre.8I3112013! <br />, FloridIi NotIIy AIIn., Inc : <br />I...... . It. II ....... ...... .................; <br /> <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Notary Public - State of F <br />11~t/-A ~;4 (.:> <br />Print or Type Commissioned Name <br /> <br />Personally Known )<) OR Produced Identification <br />Type of Identification Producea <br /> <br />DECEMBER 28. 2010 <br /> <br />70f7 <br />