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S�N�T 0.
<br /> ( J :_ f • NON -COLLUSION AFFIDAVIT
<br /> i\ •. City of Sunny Isles Beach
<br /> 18070 Cd5ns Avenue
<br /> '- �ri6o"`OQ Sunny Isles Beach,FL 33160
<br /> '•o,sus, Telephone:(305)947-0606 Fax(305)9493113
<br /> STATE OF FLORIDA
<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 riled 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 /> Jacey Investments, L.L.C. d/b/a Elite Tent Company
<br /> (Name of Corporation,Partnership,Individual,etc.)
<br /> a, Limited Liability Corporation ,formed under the laws of Florida
<br /> (Type of Business) (State)
<br /> of which he is President
<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 Ski 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 i .irecity submitted -id Bid or the contents thereof, or divulged information or data relative thereto,to any association or
<br /> to any member or ag: thereof. A�
<br /> 1
<br /> Jason R. Wells1. President
<br /> AFFIANTS NAM — `_ AFFIANTS TITLE
<br /> 4
<br /> TAKEN,SWORN • •rr SUBSCRIBED TO BEFORE ME this 23rdiay of August ,20016
<br /> Personally Known V or Produced Identification ,•
<br /> Type of identificationio�
<br /> 011iite,..- An _- -.
<br /> there) LETICIA ROMAN
<br /> '~ MY CO.MMISStON 0 FF244407 { AC(Ci Vo MG n
<br /> •'/'+ EXPIRES June 25,2019 NOTARY PUBUC(name printed or typed)
<br /> Trion tsi0153 FwriaafatiryStrqu.wm
<br /> DEcoiaeR 28,2010 1 of 7 t ;FD
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