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S°NNv rr�F <br />NON -COLLUSION AFFIDAVIT <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />oF su Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />STATE OF FLORIDAJ <br />COUNTY OFPA a 1 e ) <br />The undersigned being first duly sworn as provided by law, deposes, and says: <br />This Atfidavit is made with the <br />knowledge and Intent that it is to be <br />filed <br />with the City of Sunny Isles Beach City Commission and that it will be <br />relied upon by said County, in <br />any consideration which may give to <br />and <br />any action it may take with respect to this Bid. <br />The undersigned Is authorized to make this Affidavit on behalf of, [[.. <br />(Name of Corporation, Partnership, Individual, etc.) <br />a, 1�eczom ��aA , formed under the laws of 1 le <br />ype of Business) (Stale) <br />.J� <br />of which he is /" rG rJ/Je%n <br />(Sole Owner, Partner, President, etc.) <br />Neither the undersigned nor any person, <br />firm, or corporation named above nor <br />anyone else to fhe knowledge of the <br />undersigned, have <br />themselves solicited or employed anyone <br />else to solicit favorable action <br />for this <br />Bid by the City, also that no head of <br />any department or <br />employee therein, or any officer of the City <br />of Sunny Isles Beach, Florida Is <br />directly <br />interested therein. <br />This Bid is genuine and not collusive or a sham; the person, firm or corporation named above has not colluded, conspired, connived or agreed <br />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 <br />refrain from Bidding, and has not In any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with <br />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 <br />described above true; and further; neither the undersigned, nor the person, firm or corporation named above has directly or indirectly <br />submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent <br />thereof. (\ <br />AFFIANT'S NAME AFFIANT'S TITLE <br />TAKEN, SWORN AND SU CRIBED TO BEFORE ME this O" day of o �+ � , 20 <br />Personally Known or Produced Identification , <br />Type of identification <br />(Affix seal here) <br />m�aarr Notary Publ¢ 9taM W PlCride <br />rI' Sydney Herren <br />g J My Cemmltlleh 00 510077 <br />Aa ArP Expves 1019414075 <br />