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NON - COLLUSIONAFFIDAVIT <br /> �,__ <br /> City ofSunny <br /> venBeach <br /> \� 18070 CollinsCs Avenue <br /> •° Sunny Isles Beath,FL 33160 <br /> Or .0 <br /> '°, run ' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> r-wbs <br /> STATE OF FLOMDA <br /> ! T 1 <br /> COUNTY OF `bMGaa.n ) <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 rt 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 /> D...... M ^�^^w r <br /> (Name of Corporation,Partnership,Individual,etc.) <br /> a, Co./via P .#.J. ,formed under the laws of 1 tc-s <br /> (Type of Business) (State) <br /> . .be "' <br /> m 7 (sae O.....PS.ae.e...etci <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 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 /> �. r,s C-r—)0 <br /> AFFIANT'S NAME AFFIANT'S TITLE <br /> 1 C� /� <br /> TAKEN,SWORN AND` SUBSCRIBED TO BEFORE ME this `lam day of Mato . kg, <br /> Personally Known...Nil or Produced Identification /U1 <br /> I Type of identification <br /> ® (Affix seal here) <br /> • S. '•, J,BEN Gan OT R PUBLIC(nam printed or typed) <br /> July 26,2oie <br /> My Conunisslan Even• <br /> I <br /> I <br /> • <br /> I <br /> e <br /> O Of GEYSER 28.2010 1 of 7 <br />