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<br />--- - ------ --- <br /> <br />'V <br /> <br /> <br />ANTI-KICKBACK <br /> <br />0' ~u~ <br /> <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 94HI606 Fax: (305) 949-3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA ) <br />) <br />COUNTY OF fA\M~ch <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 Oty 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 />~ <br /> <br />By: <br /> <br />Title: <br /> <br />~~~ <br /> <br />The . foregoing instrument was acknowledged before me this ~ day of <br />j v / "1 , 20J.L, by J v ~ ~D( r-J [name <br />of person], as (Vl~ [type of authority], for <br />~ .Bb G:E<.~ \-c.: [name of party on behalf of whom instrument was <br />executed]. <br /> <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />KRYSTAL COURCHENE <br />MY COMMISSION 8 EE 000266 <br />EXP!RES: ()Ctob9f 12,2014 <br />Bllnded 1~lU NoIil'i Putll1c Untlerwnlels <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known OR Produced Identification <br />Type of Identification Produced <br /> <br />DEcEt.eER26,2010 <br /> <br />7 of 10 <br />