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SUNNY rs<F,r <br /> °� -` ` ANTI - KICKBACK <br /> i n <br /> 0City of Sunny Isles Beach <br /> ^- `. 18070 Collins Avenue <br /> ''`'951,FLOe‘° 4.• * Sunny Isles Beach,FL 33160 <br /> e")"o, su0'''o Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA P1Oncj,O3 <br /> 1.--t• ) <br /> COUNTY OF QI^(1•t-DQGI <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: sa• UP. <br /> ® The foregoing instrument was acknowledged before me this 27f'" day of <br /> f a NE , 20 )7 , by [name <br /> of person], as /4ick46(- 002/e/1-- [type of authority], for <br /> 42(6 ter view [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: ../ ' • <br /> .i' �QJ.(-J 1, • <br /> �UN J ¢ otary Public— St.' e of Flor%4 .. <br /> :.4 : ' MY COMMISSION Y FF 913313 <br /> .: ►Sa�n563 Tryz <br /> �;��a EXPIRES:August 26,2019 Lut <br /> ''?i;,`,1 '. Bonded Thru Notary Pub5c Undenrriters <br /> Print or Type.Commissioned Name <br /> Personally Known-TO YY\ OR Produced Identification <br /> Type of Identification Produced <br /> III <br /> 7 of 10 <br />