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USls Y.est NON - COLLUSION AFFIDAVIT U ._.,.._...rl x City of Sunny Isles Beach ,� _ � 18070 Collins Avenue sf '•;1-09.'° s``' Sunny Isles Beach,FL 33160 /IY O•'SUN '`• Telephone:(305)947-0606 Fax:(305)949-3113 STATE OF FLORIDA COUNTY OF M 140'1 I I,Ak) The undersigned being first duly sworn as provided by law,deposes,and says: This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be relied upon by said County,in any consideration which may give to and any action it may take with respect to this Bid. The undersigned is authorized to make this Affidavit on behalf of, 042k G 0S-R (Name of Corporation, Partnership, Individual,etc.) L � a,.ie'r-1 ? dM I OA O7 . ,formed under the laws of �L e (Type of Business) (State) of which he is Dale a w nor r TiesideA+ (Sole Owner,Partner, President,etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or employee therein,or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. This Bid is genuine and not collusive or a sham;the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person,firm or corporation,to fix the prices of said Bid or Bids of any other proposers; and all statements contained in the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2,has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto,to any association or to any member or agent thereof. CLAUbl j W-S14 l cc- eS i cl)et,+ AFFIANT'S NAME AFFIANT'S TITLE TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this ( day of '- k ,20 1 1 Personally Known or Produced Identification ; • Type of identification (Affix seal here) / • •;: NOTA- PUBLIe1a• - printer or typed) • . .�nrCO ASSION#GO283153 .� o EXPIRES:December 11.2022 ". .'.Bonded flu„Notary Public uoaarr�ars DECEMBER 28,2010