|
<br />RFQ 10-04-02 Professional Architectural Services
<br />
<br />Non-Collusive Affidavit
<br />
<br />NON-COLLUSIVE AFFIDA vir
<br />
<br />State of Florida )
<br />COlllity of Miami Dade )
<br />
<br />Thomas M. Carlson, AlA, LEED AP, Principal
<br />and says that:
<br />
<br />being first duly swom, deposes
<br />
<br />(1) He/she is the (Owner, Partner, Officer, Representative or Agent) of the Bidder that has
<br />submitted the attached Bid;
<br />
<br />(2) He/she is fully infonned respecting the preparation and contents of the attached Bid and
<br />of all pertinent circmnstances respecting such Bid;
<br />
<br />(3) Such Bid is genuine and is not a collusive or sham Bid;
<br />
<br />(4) Neither the said bidder nor any of its officers, partners, owners, agents, representatives,
<br />employees or parties in interest, including this affiant, have in any way colluded, conspired,
<br />cOllluved or agreed, directly or indirectly, with any other Bidder, fInl1, or person to submit a
<br />collusive or sham Bid in c01lllection with the Work for wluch the attached Bid has been
<br />submitted; or to refrain from bidding in cOllllection with such Work; or have in any ma1lller,
<br />directly or indirectly, sought by agreement or collusion, or c01llllumication, or conference with
<br />any Bidder, finn, or person to fix the price or prices in the attached Bid or of any other Bidder, or
<br />to fix any overhead, profit, or cost elements of the Bid price or the Bid price of any other Bidder,
<br />or to secure through any collusion, conspiracy, c01lllivance, or Imlawful agreement any advantage
<br />against the City of Smmy Isles Beach, Florida, or any person interested in the proposed Work;
<br />
<br />(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by
<br />any collusion, conspiracy, coIlIlivance, or lllilawfhl agreement on the part of the Bidder or any
<br />other of its agents, representatives, owners, employees or parties in interest, including this
<br />Affiant.
<br />
<br />~~
<br />SIGN OF AFFIANT
<br />
<br />Thomas M. Carlson, AlA, LEED AP, Principal
<br />(Printed or Typed Legal Nallle of Affiant)
<br />
<br />State of Florida
<br />
<br />ComIty of Miami Dade
<br />
<br />day of May
<br />
<br />,2010 by
<br />
<br />Swom to and subscribed before me this 25
<br />
<br />Thomas M. Carlson
<br />
<br />Jackie Ibinarriaga
<br />Notary's Name Printed, Stamped c': j'ped
<br />
<br />
<br />Notary Seal: ' ~-. J.'\CKlE IDINARRlAGA
<br />MY Il....IMmIO~ II'O[l)1UlI1
<br />. ~ t.Xtmr;s: JulY 21.lll0
<br />\"'''~HUT~K\' II. _.,'v.-.."""", 0.
<br />
<br />Personally Known: x
<br />
<br />or Produced Identification
<br />
<br />Identification Produced
<br />
|