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uNNY /S <br />� � F <br />n <br />Fr sEO�' oy <br />0, SUN R� <br />STATE OF FLORIDA ) <br />COUNTY OF DQ6) <br />ANTI - KICKBACK <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 />ANTI - KICKBACK AFFIDAVIT <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: <br />Title: Sf l � <br />The foregoing instrument was acknowledged before me this day of <br />C , 20 It , by J� �h J- m b)-i [name <br />of pers n], as So. rr fri Aj i T_( -,ctLc vc r' [type of authority], for <br />pe%(c [name of party on behalf of whom instrument was <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />Dl►ow MINA <br />NOTARY PUBLIC <br />STATE OF FLORIDA <br />t oram# DD96O `W <br />Expires W0`114 <br />Personally Known <br />Type of Identification Produced <br />co1.ls/`-- <br />Notary Public — State of Florida <br />D 6t i n i y 1Vi l ib- <br />Print or Type Commissioned Name <br />OR Produced Identification <br />DECEMBER 28, 2010 7 of 7 <br />