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<br /> ® =/ -o 41 NON - COLLUSION AFFIDAVIT
<br /> ® : 17
<br /> City of Sunny Isles Beach
<br /> or..,
<br /> � 18070 Collins Avenue
<br /> '44n '•r 1o" o•' Sunny Isles Beach,FL 33160
<br /> m su$ ' Telephone:(305)947-0606 Fax:(305)949-3113
<br /> STATE OF FLORIDA
<br /> ® )
<br /> COUNTY OF Broward )
<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 /> ® Keefe McCullough
<br /> ® (Name of Corporation,Partnership, Individual,etc.)
<br /> 0 a, partnership ,formed under the laws of Florida
<br /> (Type of Business) (State)
<br /> of which he is Managing Partner
<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 Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
<br /> ® 10.2,has directly or indirectly s bmitted said Bid or the contents thereof, or divulged information or data relative thereto,to any association or
<br /> to any ember or agent there.i
<br /> ® P �Ek
<br /> ® ,....r;
<br /> AFFIANTS AME AFFIANT'S TITLE
<br /> ® TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day of 1�QC.e nh2.x-- ,204c
<br /> ® Personally Known X or Produced Identification
<br /> Type of identification
<br /> ® (Affix seal here) , q.eadel
<br /> ®
<br /> NOTARY PUBLIC(name printed or typed)
<br /> ® o
<br /> KAIfL1M F.(XIUBECK
<br /> �'YLT.•/l a 1.
<br /> to MY COMMISSIONaFFf234866
<br /> 1 EXPIRES:MAY 27,2019
<br /> ® "sr kids through 1st State Insurance
<br /> 0
<br /> 0
<br /> ® DECEMBER 28,2010 1 of 7
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