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SUNNY/S4E <br /> OAte`' ;,... <br /> ANTI - KICKBACK <br /> z11111 <br /> City of Sunny Isles Beach <br /> r' 18070 Collins Avenue <br /> gyp .1 0t <br /> � ' v 0-'00t <br /> a Sunny Isles Beach,FL 33160 <br /> ''op sus' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • <br /> ANTI-KICKBACK AFFIDAVIT <br /> STATE OF FLORIDA ) <br /> COUNTY OF ?Ai-' B (1f) <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: 'Piz ES Z.00—,v- " <br /> The foregoing instrument was acknowledged before me this .)-1 T"../ day of IP <br /> , 20 It? , by ( 111)-\/T.0 L)63B c?5,z [name <br /> of person], as viC_C 'R-65IDE toT [type of authority], for <br /> Aft ACUS TE2errfe 7 C . [name of party on behalf of whom instrument was <br /> executed]. <br /> AFFIX NOTARY STAMP HERE: <br /> NICHOLAS LEE Notary Public — State of Florida <br /> =•° Commission# FF 982474 <br /> •,fisl'.ti My Commission Expires lQiCHDLA 5 (—C C <br /> � V.1,ss�s April 14, 2020 <br /> Print or Type Commissioned Name <br /> • <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> 7 of 10 <br />