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(10-04-01) Prof. Engineering Svcs.
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Last modified
11/17/2010 11:26:28 AM
Creation date
11/17/2010 11:26:01 AM
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. Engineering Svcs.
Bid No. (xx-xx-xx)
10-04-01
Project Type (Bid, RFP, RFQ)
RFQ
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<br />NON-COLLUSIVE AFFIDA VIT <br />State or Florida ) <br />Count:- or Broward ) <br />Edwin Mojena, PE <br />and sa) s that: <br /> <br />heing fir~l dul:- ~\\ om, depo~~s <br /> <br />( I ) He/she i~ the (0\\ ner, I'anner, Omcer. R~pr~sentati\e or Agent) of the Hidder thaI ha~ <br />submitted the attal:hed Bid: <br /> <br />(2) lie/she is full:- informed respecting the preparation and wnlents of the anached Bid and <br />of all peninent circumstanc~s respecting such Hid: <br /> <br />(3) Such Did is genuine and is not a collusive or sham Bid: <br /> <br />(4) Neither the said bidder nor any of its officers, panners, 0\\ ners, agent~, represental h es, <br />emplo) ees or panies in interest, induding this alliant, have in an) w <i:- colluded, conspired. <br />wnnived or agre~d, directly or indirectl). with any other Bidder, firm, or pi:rson to submit a <br />collu~i\ e or sham Did in l:Onnection \\ ith the Work for which the attached Bid has heen <br />submitted: or to refrain from bidding in connection with such Work: or have in an) manni:r. <br />directly or indirectl), sought b) agr~emelll or collusion, or communication, or conferi:nce wilh <br />an:- Bidder, firm, or person to Ii;.. the price or prices in the allach~d Bid or of an) other Bidder. or <br />to fix an) overhead, profit. or cosl elements of the Bid price or the Did price of any other Bidder, <br />or to secure through an:- collusion. conspirac), connivance. or unlaw ful agr~ement an) advantage <br />against the ('it) of Sunn:- Isle~ Heach. rtorida. or any person interested in the proposed Work: <br /> <br />(5) The prict.' or prices quoted in the allached Bid are fair and proper and arc not tainted b) <br />any collusion, conspimcy, connivanc~. or unlawful agreemelll on the pan of the Bidder or an) <br />other of its agents, representatives, lJ\\ ners, employees or panies in interest. including this <br /> <br />An;;~ n . <br />L I Edwin Mojena <br /> <br /> <br />SIG T 'FIANT (Printed or Typed Legal Name of Aman!) <br />State 0 Florida Coun" of Broward <br />. . <br /> <br />Sworn to and subscribed betore me Ihi~ 24 t~ day of May <br />Edwin Mojena, PE <br /> <br />, 20 I 0 h~ <br /> <br />ry '{\f\()"..A ~ ~~I NOlar~ Seill: <br />~t~ry's ~:~P~~~ ~~mp~d 'o~';O <br /> <br /> <br />Per~onally KnO\\n: X or Produced Identification <br /> <br />11"'"" .MAAy.ANNPADRo..........s <br />\..,\111111,~",. Comm# 000859742 : <br />_\ ~"!l!..1< . <br />'~~'!I.v." . <br />~: " ~ Expires 2/612012 ~ <br />..~ ~<" . <br />-:-"II~r;\\\\~ Florida Notary Assn.. Inc : <br />.................................".,........, <br /> <br />Identi ticatioll Produced <br />
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