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r <br /> tSJNur'S,Ff <br /> _ ANTI - KICKBACK • <br /> City of Sunny Isles Beach <br /> • - � <br /> tip ' 18070 Collins Avenue <br /> '/-'.,ioc'sSunny Isles Beach,FL 33160 <br /> `''.o, ,v„''' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF Broward ) <br /> • <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 /> By: <br /> Title: CEO <br /> The foregoing instrument was acknowledged before me this ?A day of <br /> 101%)191-1/4-1 , 20 1 , by An6rG (amu s. [name <br /> o person], as C 0 [type of authority], for <br /> 0...� ,. - _ Kt OK , ,.' [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: / <br /> • Fr• R•lic — State of Florida <br /> 0*1.0 DAM SALDARRIAOA r <br /> -•• 'r: PAY C:PMAISS10N A FF247231 iir <br /> isiEXPIRES July 07,2010 DAN•D S►-IAAQ-ft-lA� 4. <br /> (gm gm),s3 eriaso Print or Type Commissioned Name <br /> Personally Known X OR Produced Identification • <br /> Type of Identification Produced • <br /> DECEMBER 28.2010 7 of 10 <br /> I <br />