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<br />NON-COLL USION AFFIDAVIT <br /> <br />By submission of this affidavit, the Proposer certifies that this price is made independently and free from <br />collusion. Proposer shall disclose below, to the best of its knowledge, any City of Oakland Park officer or <br />c:mployee, or any spouse, son, daughter. stepson, stepdaughter, or parent of any such officer or employee, <br />who is an officer or director of, CJt has a material interest in. the Proposer's business who is in a position to <br />influence this procurement. Any City of Oakland Park officer or employee who has any input into the <br />writing of spe.cifications or requiremen~ solici1Bt:ion of offers, decision to award, evaluation of offers, or <br />any other activity pertinent to tins procurement is presumed, fCJt ptuposes hereof. to be in a position to <br />infiue:;uce this procurement. For purposes hereof: a person has a material interest iihe or she directly or <br />indirectly owns more than five percent (5%) of the total assets or capital stock of any business entity, or if <br />he or she otherwise stands to personally gain if the contract is awarded to this vendor. <br /> <br />Failure of a vendor to disclose any relationship described herein shall be reason for debarment in <br />accordance with the provisions of the City of Oakland Park Code of Ordirumces. <br /> <br />NAME <br />N/A <br /> <br />BELA TIONSHlPS <br /> <br /> <br />Sworn to and subscribed before me . <br />A11'J"c:t -,20 03 <br /> <br />the state and county first mentioned above on this -11- day of <br />~,\,,,II"'''',,,,1. <br />~,\'\l D\E MARl' """ <br />$~~V:........:!J' 41~ <br />.;::. ,,- -.~...;. <br />~ ,.' NOTARY ... ~ <br />- . - <br />~ : PUBLlC ~~. <br />= . . - <br />::; ~ AT .;- <br />% C.pf~@i~ ..: i <br />~ -. ..~ ~ <br />~ /J.... . ""-~ <br />~~~~~.~~~,~~ <br />"",~:~~.\",~ <br />"",,,", '" I"" <br /> <br /> <br />Marrs <br /> <br />J'ulv.21, 2007 <br />My commission expires <br /> <br />SIB <br />