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<br />) <br /> <br />I ) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />) <br />I ) <br />I I <br />I i <br />I <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 tt\ \Jlr(f\\" \)~~ <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: C, A-~ fi,if <br /> <br />Title: r 1.-, ~ I r ~ (.." <br /> <br />I I <br /> <br />-" Th~ foregoing instrument was aq,"owledged before me this tJ/.-f1J day of <br />~~'J , 2011L, by ~)i~~~j~' PI\.\)~'iI [name <br />of person], as -r~\r-J(.,l PI! v [type of authority], for <br />~f'''''~i- ~~""J'i'1 ~~I':5 [name of party on behalf of whom instrument was <br />executed] . <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br /> <br />Personally KnOW~ OR Produ;:ed Idztification <br />Type of Identification Produced D~ V~"'\. ~.~ <br /> <br />DECEMBER 28,2010 <br /> <br />7of7 <br />