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0 <br /> ANTI - KICKBACK <br /> V - j1 3 <br /> O City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> O • ''•,F • <br /> Sunny Isles Beach,FL 33160 <br /> Fora iu@ 0`9 Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ANTI-KICKBACK AFFIDAVIT <br /> O <br /> O <br /> STATE OF FLORIDA ) <br /> ® COUNTY OF Palm Beach ) <br /> O <br /> o I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br /> O 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 /> Iv- <br /> By: <br /> ry l gram, P. . <br /> Title: Senior Vice President/Principal Associate <br /> O <br /> ® The foregoing instrument was acknowledged before me this 30th day of <br /> ® April , 20 12 , by Jerry Ingram.P.E. [name <br /> of person], as Senior Vice President/Principal Associate [type of authority], for <br /> ® Kimley-Hom and Associates, Inc. [name of party on behalf of whom instrument was <br /> o executed]. <br /> AFFIX NOTARY STAMP HERE: 7 p <br /> ® 7 -/Y)yyl y /-ekc u c%-&' <br /> ii:i® TAMMY L SCARLOTT Notary Public — State of Florida <br /> O <br /> MY COMMISSION#EE181709 � <br /> EXPIRES January ary 19.2018 //9n-yn>/ '2 ,5c."9"--/, E <br /> (407;1;164103 <br /> FlOrfttlattrytlerNee.eon Print or Type Commissioned Name <br /> O <br /> Personally Known x OR Produced Identification <br /> Type of Identification Produced <br /> O <br /> O <br /> O <br /> O <br /> O <br /> O DECEMBER 28,2010 7 of 7 <br /> O <br />