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O rONT:I�Ef <br /> 7J •- <br /> ® ,�_' ANTI - KICKBACK <br /> ® `? City of Sunny Isles Beach <br /> �� 18070 Collins Avenue <br /> tib _ :•.suo10° � ' Sunny Isles Beath,FL 33160 <br /> o.iue' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> 0 <br /> 0 <br /> ® STATE OF FLORIDA ) <br /> • AjmB� ) <br /> COUNTY OF ) <br /> 0 <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 /> 0 <br /> • <br /> ® By: <br /> — • (,l <br /> gram, P.E. <br /> ® Title: Senior Vice President/Principal Associate <br /> 0 <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/PrincipalAssociate [type of authority], for <br /> ® Kimley-Hom and Associates, Inc. [name of party on behalf of whom instrument was <br /> • executed]. <br /> O AFFIX NOTARY STAMP HERE: p <br /> ® 7a/19 Z- —�J C"GvtArff <br /> ® Notary Public — State of Florida <br /> O TAMMY L SCARLOTT // � c^��/� /L <br /> ® MV COMMISSIONS EE161709 /Hm/� (/� .,Y <br /> • • EXPIRES January 19,2016 Print or Type Commissioned Name <br /> ® (40?i 264153 FlMisNot rySs ia..e ., <br /> • Personally Known x OR Produced Identification <br /> ® Type of Identification Produced <br /> • <br /> • <br /> ® DECEMBER 28,2010 7 of 7 <br />