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<br />SECTION 10
<br />
<br />NON-COLLUSION AFFIDAVIT
<br />
<br />STATE OF FLORIDA
<br />i'\ A oa
<br />COUNTY OF l>'"
<br />
<br />)
<br />)
<br />)
<br />
<br />The undersigned being first duly sworn as provided by law, deposes, and says:
<br />
<br />10,1. This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny
<br />Isles Beach City Commission and that it will be relied upon by said County, in any consideration which
<br />may give to and any action it may take with respect to this Bid.
<br />
<br />10.2. The undersigned is authorized to make this Affidavit on behalf of,
<br />
<br />\UJA /oJ So~ LAN~C4--piI-l" COr2.~eA\~CN
<br />(Name of Corporation, Partnership, Individual, etc.)
<br />
<br />a, l.,f"'lIj~tr' U::r.,~ , formed under the laws of
<br />(Type of Business)
<br />
<br />q tsHtPG61.. /.{ -bt4-6tfie
<br />(Sole Owner, Partner, President, etc.)
<br />
<br />T10~I{~
<br />(State)
<br />
<br />of which he is
<br />
<br />10,3, Neither the undersigned nor any person, firm, or corporation named in above Paragraph 11.2,
<br />nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone
<br />else to solicit favorable action for this Bid by the City, also that no head of any department or employee
<br />therein, or any officer of the City of Sunny. Isles Beach, Florida is directly interested therein.
<br />
<br />10.4, This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in
<br />Paragraph 11.2 has not colluded, conspired, connived or agreed directly or indirectly with any bidder or
<br />person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain
<br />from bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or
<br />communication or conference with any person, firm or corporation, to fix the prices of said proposal or
<br />proposals of any other bidder; and all statements contained in the proposal or proposals described above
<br />true; and further; neither the undersigned, nor the person, firm or corporation named above in
<br />Paragraph 11.2, has directly or indirectly submitted said proposal or the contents thereof, or
<br />divulged information or data relative thereto, to any assOciation or to any member or agent thereof.
<br />
<br />&/' e:~
<br />
<br />AFFIANT'S NAME AFFIANT'SiTITLE
<br />
<br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this:5 day of VCCenlOtr
<br />
<br />Personally Known V or Produced Identification
<br />Type of identification
<br />
<br />L~i6:.'1 (;y""'I/~
<br />
<br />Gtnf~ ~~
<br />
<br />, 200~1
<br />
<br />( ,,".":"""t,. I ~ " i,1Jriinez
<br />, "J . .
<br />
<br />'~GLlll\--d~ ~~.~~"jt. . 10..\ .,cl8c~8?1..7Jl180
<br />)\ I J \ 1 ~ '~1't:. _. .~. _0 f" \J. '",
<br />NOTARY PUBLIC (nameynnted or. typed): or, rJ OTARY com
<br />
<br />(Affix seal here)
<br />
<br />END OF SECTION
<br />
<br />PAGE 70 OF 92
<br />BID No. 07-10-04
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