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<br />c <br /> <br /> <br />ANTI-KICKBACK <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 ) <br />) <br />COUNTY OF D<,o~4'~) <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 s Bea h or its elected officials as a <br />commission, kickback, reward or gift, directly or indo ectly by e r mber of my firm or <br />by an officer of the corporation. <br /> <br />By: <br /> <br /> <br />Title: <br /> <br />c <br /> <br />The foregoing instrument was acknowledged before me this \ day of <br />3" u...", '- , 20-1L, 9Y <;o....r~ ~c..(':, u~..... [name <br />of person], as ~o('" t..~ \~4.. -~ [type of authority], for <br />t..t>Q.~" tonliro . 'bQ,..... ~~~ [name of party on behalf of whom instrument was <br />executed] . <br /> <br /> <br />~~E~ON <br />J'a~N\'fEf\OC" ~ 00 B4~fl~4 <br />Ol;'~~\e{\\" ~ ~O''3 <br />""i cl'\~as~ w,aICI'I r U~d'r<iti\e{$ <br />~~ IMll'lO\ll'/ jlU~\ 0 <br />lIonu~v <br /> <br /> <br />C\\)~ 5~ <br />Notary I~c State of Florida <br /> <br />:r e. "" ~.c eo/'" to... m <Z.ro ~ <br />Print or Type Commissioned Name <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Personally Known./ OR Produced Identification <br />Type of Identification Produced <br /> <br />- <br /> <br />.... <br /> <br />DECEMBER 28, 2010 <br /> <br />7 of 10 <br />