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<br /> .• SJ$NY Isle .
<br /> a € ." 7 NON - COLLUSION AFFIDAVIT
<br /> •
<br /> City of Sunny Isles Beach
<br /> 18070 Collins Avenue
<br /> 91,FLOP'oo'.` Sunny Isles Beach,FL 33160
<br /> 'or sus'' Telephone:(305)947-0606 Fax:(305)949-3113
<br /> STATE OF FLORIDA
<br /> )
<br /> COUNTY OF /44.-k(f ��C.�•,Q
<br /> The undersigned being first duly sworn as provided by law,deposes,and says:
<br /> 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
<br /> relied upon by said County,in any consideration which may give to and any action it may take with respect to this Bid.
<br /> The undersigned is authorized to make this Affidavit on behalf of,
<br /> C . 0 ei .
<br /> (Nae of Corporation,Partnership, Individual,e*.)
<br /> a, 0--0Y ,formed under the laws of R-401`1
<br /> (Type
<br /> hof usiness) (State)
<br /> of which he is
<br /> (Sole Owner,Partner,President,etc.)
<br /> Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the
<br /> undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any
<br /> department or employee therein,or any officer of the City of Sunny Isles Beach,Florida is directly interested therein.
<br /> 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,
<br /> 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
<br /> corporation,shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion,or communication
<br /> 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
<br /> the Bidr Bidsdescribed desc abed above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
<br /> 10.2,has directly or indirectly submitted said Bid or the contents thereof,or divulged information or data relative thereto,to any association or
<br /> to any member or agent thereof.
<br /> q4110 G5 .
<br /> A Fl NTS NAME AFFIANT'S TITLE
<br /> TAKEN,SWORN AND SU CRIBED TO BEFORE ME this 4' day
<br /> of J ,20
<br /> Personally Known or Produced Identification_ •
<br /> Type of identification
<br /> (Affix seal here
<br /> �►G LUCIA ESTRELLA A`/
<br /> %;'�A' " •; MY COMMISSION#GG 121005 NO . P. LIC(name printed or typed)
<br /> =
<br /> •: hind ••:
<br /> EXPIRES:July 4,2021
<br /> "','FOFFCP', ruPublicUnderwritere
<br /> •
<br /> Bonded Th Notary
<br /> DECEMBER 28,2010
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