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o` 00Nr <br /> I (1.0 "la 7n <br /> ANTI - KICKBACK <br /> City C.) <br /> • `'�� City of Sunny Ides Beach <br /> • <br /> DS � 18070 Collins Avenue <br /> sic � FLOP\ o+ Sunny Isles Beach,FL 33160 <br /> oc suN'M Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF fo✓Uviiik ) <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 /> By: <br /> Title: <br /> • The foregoing instrument was acknowledged, before me this 010 day of <br /> t y / , 20 ).- , by F(-1116107) [name <br /> of pe son], as V-P i [type of authority], for <br /> ion Sub [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> .lv 'h4 ` <br /> 4P,'.r Notary Public State of Florida Nota Public — afte of Florida <br /> Renee M Liber <br /> �ry1oF 4 .; My Commission 150287 f�-oo4P Expires 112/13/2015 C <br /> t�r�� <br /> Print or Type Commissioned Name <br /> Personally Known OR Produced Identification U <br /> Type of Identification Produced /,4 OL j-r “,o50 g102, <br /> C <br /> DECEMBER 28,2010 7 of 10 <br />