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® E,yJN I\Ff� <br /> • =�' f ANTI - KICKBACK <br /> City of Sunny Isles Beach <br /> ® 18070 CdGns Avenue <br /> '.v r'• c E o' r Sunny Isles Beads,FL 33160 <br /> c <br /> Telephone:(305)947-0806 Fax:(305)9433113 <br /> ® ANTI-KICKBACK AFFIDAVIT <br /> ® STATE OF FLORIDA ) <br /> COUNTY OF Palm Beach ) <br /> 9 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: Doug Riordan <br /> ® Title: Sole Owner / President <br /> ® fhe foregoing instrument was acknowt ed before me this 5/ day of <br /> , 20/1—, by 1)0 ,5-/Q s f t'o,cG> AJ [name <br /> ® of /person], as President / Sole Owner [type of authority], for <br /> ® Stockton Maintenance Group [name of party on behalf of whom instrument was <br /> executed]. <br /> • AFFIX NOTARY STAMP HERE: <br /> d4.:i,W I• E Y E JOSCi lTh /Notary <br /> Public — State of Florida <br /> M C0SSM rsfor a EPa;o 9 <br /> J6':".ES:Mm-.2o1.2016 p <br /> Print or Type Commissioned Name <br /> ® Personally Known X OR Produced Identification <br /> Type of Identification Produced <br /> 0 <br /> • <br /> • <br /> • <br /> ft <br /> ® DECEMBER 28,2010 7 of 10 <br />