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<br /> <br />ANTI-KICKBACK <br /> <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949,3113 <br /> <br />ANTI-KICKBACK AFFIDAVIT <br /> <br />STATE OF FLORIDA <br />COUNTY OF ~Je- <br /> <br />) <br />) <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 /> <br />By: <br /> <br />7ffP <br />f-p, 'fQVc\ seJ2()iC,-QS btVl5io>J <br />" <br /> <br />Title: <br /> <br /> <br />instrument was ~cl<no'1ledged; b~fore Il)e this /1 day of <br />20j!} ,by OA/;~tl(} fL(()/)IMjilC/tJ [name <br />[type of authority], for <br />[name of party on behalf of whom instrument was <br /> <br />of <br /> <br />executed] . <br /> <br /> <br />90~ P(I Notary Public State of Florida <br />o'~ ,"':' \ RamOs <br />~" ". Isbe "EE130802 <br />. Jli .. My Commission <br />~ ~./" f Expires 0911612015 <br />~Ofl\.o <br /> <br /> <br /> <br />AFFIX NOTARY STAMP HERE: <br /> <br />Print or Type Commissioned Name <br /> <br />Personally Known OR Produced Identification <br />Type of Identification Produced r.--1JI- <br /> <br />PlJL <br /> <br />DECEMBER 28,2010 <br /> <br />7 of 7 <br /> <br />, 1/ L /' ~-^II./1 LL, A> ~111 1/, C (i'~ tc.. Q-A=!'tC, rE r'S , <br />J-L-..:> lp, v '1~ ( L..- 0-- b ILl. R~ iJo.. 1.;;>. - 0 3' - 0 'd- <br /> <br />~C:?-' 3d- <br />