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BID TITLE: BID 19 -17 -12 -HR BID NUMBER: ROOFING MAINTENANCE & REPAIRS <br />SCHEDULE "B" <br />CITY OF SUNRISE <br />NON -COLLUSION AFFIDAVIT <br />This affidavit is to be filled in, executed and notarized by the Bidder. If the bid is made by a <br />Corporation, then it should be executed by its Chief Officer. This document MUST be submitted with <br />the bid. <br />STATE OF ) <br />) SS <br />COUNTY OF ) <br />being first duly sworn, deposes and says <br />that <br />(Type or print name of person who is signing below) <br />He/she is the (Owner, Partner, Officer, Representative or <br />Agent) <br />of the Bidder that has submitted the attached Bid. <br />2. He/she is fully informed with respect to the preparation and contents of the attached Bid and of all <br />pertinent circumstances respecting such Bid. <br />3. Said Bid is made without any connection or common interest in the profits with any other persons <br />making a Bid for the said commodities/services. Said Bid is on our part in all respects fair and <br />without collusion or fraud. No head of any department, any employee or any officer of the City of <br />Sunrise is directly or indirectly interested therein. If any relatives are employed by the City, indicate <br />name and relationship below. <br />Name: Relationship: <br />Name: Relationship: <br />Company Name: <br />Bidders' Authorized Signature: <br />Subscribed and sworn to before me this <br />Notary Public <br />(Print, Type or Stamp name of Notary Public) <br />Personally known or Produced I.D. <br />Type and number of I.D. Produced: <br />day of 120. <br />Revised 6/27/18 Page 71 <br />