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<br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF ~ ) <br /> <br />ANTI-KICKBACK <br /> <br />City of Sunny Isles Beach <br />18070 COllins AII1l11ue <br />Sunny Isles Beach. Fl 33160 <br />Telepllone: (305) 947-0606 Fax: (305) 949-3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <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 />!f~ )~, <br /> <br />Title: <br /> <br />The foregoing instrument was acknowledged before me this ~ day of <br />M~ ' 20...LL, by 6~<;. <"2:..ILl~ A [name <br />o( per n], as Pt2~liiwJ1' . [type of authority], for <br />Pr4:r/'r O"'A-l~1F;'vN ~IA'~ [name of party on behalf of whom instrument was <br />executed]. <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />.. <br />t-r.. <br /> <br /> <br />ilTEOI'lMO <br />MYOOIoIMlIlSDf III!II2I8'IIS <br />~ EXPIJIIlS:Ocdor28,2014 <br />~AJ.Y PI. NCIlIl)'~AIIocl. Co. <br /> <br />{JA~A ~ <br /> <br />Notary PUblic - State of Florida <br /> <br />~f,~ &~~ <br />Print or Type Commissioned Name <br /> <br />Personally Known V OR Produced Identificijtion <br />Type of Identification Produced <br /> <br />OECEM8E11 28. 2010 <br /> <br />7of7 <br /> <br />.. <br /> <br />" <br /> <br />.J <br />