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0 <br /> ® ♦V TINY ij, i <br /> �' ..� ANTI - KICKBACK <br /> v - z <br /> ® - : City of Sunny Isles Beach <br /> ® '= *' 18070 Collins Avenue <br /> %��''• .10`�� �' Sunny Isles Beach,FL 33160 <br /> ® ''o, /M ..‘e Telephone:(305)447.0606 Fax:(305)949-3113 I <br /> ® ANTI-KICKBACK AFFIDAVIT ' <br /> ® STATE OF FLORIDA ) ' <br /> 0 ) <br /> COUNTY OF Palm Beach ) <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 /> 0 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: Doug Riordan <br /> BTitle: Sole Owner / President <br /> ® /The foregoing instrument as acknowle�ed before me this , day of <br /> �/—� .0 , 20/ .--, by was <br /> s 1 1`� '•o.0 D A ,.- [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 /> 0 executed]. <br /> ® ' <br /> O AFFIX NOTARY STAMP HERE: <br /> -9:ri lt• - V: tiOSC}E tir /Notary ublic — State of Florida • <br /> • MY COME tS►OSC t i. rY <br /> MY cosi�!1ss;ox s EE1;v,9 <br /> ® 5 EX':•�.ts:M.--101.2016 C <br /> ' 17T/TY l Nnav,'h= .Ca <br /> Print or Type Commissioned Name <br /> • 0 <br /> ® <br /> ® � <br /> Personally Known OR Produced Identification <br /> Type of Identification Produced <br /> ® <br /> ® a <br /> ® DECEMBER 28.2010 7 of 10 <br />