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<br />'t <br /> <br />... <br /> <br /> <br />ANTI-KICKBACK <br /> <br />01 ~\lt~ <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 fA \ "^ ~c.h <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 />ctP <br /> <br />Title: rv\.9-...~~ .~ <br /> <br />The foregoing instrument was acknowledged before me this g- day of <br />jv/'1 , 20.lL, by Jv~ HeADttV [name <br />of person], as M~ [type of authority], for <br />~ .Bb GR~ L [name of party on behalf of whom instrument was <br />executed] . <br /> <br />AFFIX NOTARY STAMP HERE: ~ <br /> <br />Notary Public - State of Florida <br /> <br />.,..,,".. KnYSTALCOURCHENE <br />..",.f''f PP"~'t:'l 6 <br />!~~A"" ~~'. MY COMMISSION # EEOOO26 <br />t:. " f~,' EXpIRES: October 12,2014 <br />~i',,,,,..t.; Bonded Thru Notary Pubhc Underwnters <br />'~',nfllf;\"" <br />~ <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br /> <br />DECEMlER28,2010 <br /> <br />7 of 10 <br />