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sop1NY Is,e <br /> ANTI - KICKBACK <br /> F <br /> 7n <br /> ® Vw <br /> `• , - City of Sunny Isles Beach <br /> �`_ 18070 Collins Avenue <br /> ''‘,D 9'•r I o a\o 5`° Sunny Isles Beach,FL 33160 <br /> c'''o. sus 04° Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> ) <br /> COUNTY OF _ ) <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 /> 1 / aVe&______ <br /> By: <br /> Title: t//2a OF Sites <br /> IDThe foregoing instrument was acknowledged before me this /9 day of <br /> 4q� , 20 (� /, by e6/ O/�1�=c. s+" [name <br /> of person{J; as D/f2E- 12 OF S -e `[type of authority], for <br /> _ /2D/F oNs+Lc� name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: Qthti\e - <br /> „,%;.p%1,:;,,,,, <br /> ��YP�� RONALD STERLING ANDERSON Notaiy Public — State of Florida <br /> � fief . <br /> +' "`1 `, Notary Public-State of Florida ' <br /> Commission#GG 046746 Qpy i�S. A �PeQ/b� <br /> -„,!,� ` .•' My Comm.Expires Nov 14,202' ✓? <br /> 1Bondedthrough National NotmyAlai: f-- - Print or Type Commissioned Name <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> III <br /> 7 of 7 <br />