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® SJN <br /> ® cP <br /> ANTI -KICKBACK <br /> ® _ • City of Sunny Isles Beach <br /> 18070 Corns Avenue <br /> sP 9'-•F1.09.‘ S` Sunny Isles Beach,FL 33160 <br /> or s��' Tom:(305)947-0606 Fax:(305)949-3113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> ® STATE OF FLORIDA ) <br /> ® COUNTY OF OOPJ Q— ) <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: Nechelle Morales <br /> Title: President <br /> ® The foregoing instrument was acknowledged before me this I0 day of <br /> ® acQnYlh , 20 12-, by arrl^\a ;39-(lk1►J1 [name <br /> ® of person], as Nr)-Ear Pcib Ilk [type of authority], for <br /> c)-N e I►c M v raj('_s [name of party on behalf of whom instrument was <br /> executed]. <br /> ® AFFIX NOTARY STAMP HERE: <br /> 0 <br /> ® ' ty • % t-r1116 <br /> Samantha Jenkins Notary Public—State of Florida <br /> r --�` ••• NOTARY PUBLIC f n� <br /> ® `j( 2 STATE OF FLORIDA rn(n <br /> ® corn.CoGG145197 <br /> E 19 Expires 9/21/2021 Print or Type Commissioned Name <br /> Personally Known OR Produced Identification <br /> ® Type of Identification Produced FL OC- CG(-fa-6.2S- 9 -W3--c) <br /> 0 <br /> S <br /> ® 7 of 7 <br /> rfe----(;ki9e A T v rte k t_cc vefid- - M Q 11-it-b1 <br />