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<br />NON-COLLUSIVE AFFIDA vIr
<br />
<br />State of~r)lJ
<br />
<br />County of
<br />
<br />12ALL-)
<br />
<br />~()T?()
<br />and says that:
<br />
<br />being first duly sworn, deposes
<br />
<br />(I) 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 circumstances 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 />connived or agreed, directly or indirectly, with any other Bidder, firm, or person to submit a
<br />collusive or sham Bid in connection with the Work for which the attached Bid has been
<br />submitted; or to refrain from bidding in connection with such Work; or have in any manner,
<br />directly or indirectly, sought by agreement or collusion, or communication, or conference with
<br />any Bidder, firm, 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, connivance, or unlawful agreement any advantage
<br />against the City of Sunny 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, connivance, or unlawful agreement on the part of the Bidder or any
<br />other of its agents, representatives, owners, employees or parties in interest, including this
<br />A ffi nl.
<br />
<br />
<br />-ANOUE~ 7QW
<br />(Printed or Typed Legal Name of Affiant)
<br />State offlCh~ounty of fu-cLc.
<br />
<br />Sworn to and subscribed before me this ~ ft,
<br />
<br />day of Jv10Lf
<br />
<br />,2010 by
<br />
<br />~
<br />
<br />",\\\lilllj/'",~ .
<br />,"'\\~\t.UDEZ 1111.1.
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<br />1!1""''''ll\''~'
<br />
<br />
<br />Personally Known:
<br />
<br />--- or Produced Identification
<br />
<br />Identification Produced
<br />
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