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<br /> ' I CITY OF SUNNY ISLES BEACH
<br /> 1. .).: -SECTION SIX: CONTRACT FORMS •
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<br /> O ..,301•17..,301•17 1:144.
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<br /> 0 di,_ NON - COLLUSION AFFIDAVIT
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<br /> V City of Sunny Isles Beath
<br /> 018070 Collins Avenue
<br /> `• ','•n o) +`t Sunny Isles Beach,Ft. 33160
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<br /> o. .o+ '"o Telephone:(305)947-0606 Fax:(305)9433113
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<br /> 0 STATE OF FLORIDA )
<br /> 0 COUNTY OF Broward >
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<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 /> O The undersigned is authorized to make this Affidavit on behalf of,
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<br /> • Keith and Schnars
<br /> (Name of Corporation,Partnership,Individual,etc.)
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<br /> 0 a, corporation ,formed under the laws of Florida
<br /> (Type of Business) (State)
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<br /> • of which he is Vice President
<br /> (Sole Owner,Partner,President,etc.)
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<br /> O 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 /> O This Bid is genuine and not collusive or a sham;the person,firm or corporation named above in Paragraph 10.2 has not cofuded, 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 /> 0 corporation, shag 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 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
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<br /> 0 Mark Tomczyk,P.E. Vice President
<br /> ® AFFIANTS NAME AFFIANTS TITLE
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<br /> • TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day of 1,C4C1 ` ..2,9,520/2
<br /> • Personally Known 1/ or Produced Identification • I
<br /> • Type of identification
<br /> ® (Affix seal here) 1 alp
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<br /> ® . a1 WMAMBE�1 7PRO K116 NO PU= C name printed or typ-.
<br /> • s?tea,`,""�= EXIRES Fetwary 13 2016
<br /> ' &Med lbs Mary Pt&Ud n
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<br /> r,._>.. — - :l�]J"'_ FIDWDAY$ LDGLL FIRMA.
<br /> RFQI2-04-02 PAGE 51
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