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<br />CITY Of SUNNY ISLES BEACH
<br />SECTION THREE: ADDITIONAL INFORMATION
<br />
<br />NON-COLLUSIVE AFFIDA VIT
<br />
<br />State of Florida)
<br />
<br />County of
<br />
<br />Miami-Dade)
<br />Mark Tomczyk, P,E.
<br />
<br />being first duly sworn, deposes
<br />
<br />and says that:
<br />
<br />(I) He/she is the (Owner, Partner, Onicer, Representative or Agent) of the Bidder that has
<br />submitted the attached Bid;
<br />
<br />(2) He/she is fully informed 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 onicers, 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 />
<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 />
<br />;!/t){~
<br />SIGNA TURE OF AFFIANT (Printed or Typed Legal Name of Affiant)
<br />Slate orJ'J.Jlt(014 Couoty O@~L.UA~
<br />Sworn to and subscribed before me this ~ day of
<br />k ~ Q...2::.. ~
<br />
<br />Mark Tomczyk, P,E.
<br />
<br />
<br />, 20 I 0 by
<br />
<br />Notary Seal:
<br />
<br />e Printed, Stamped or Typed
<br />~
<br />Personally Known: or Produced Identi fication
<br />
<br />+",.~V.~~6('0 JOl-PHYLE HAU.EM
<br />'" &~ . MY COMMISSION f DO 984318
<br />"'~.. EXPIRES; May 10, 2014
<br />""'f Of f\ o~~ 80nded Thru Budget NolIry SeMcu
<br />
<br />Identi fication Produced
<br />
<br />RFQ#10-04-01
<br />
<br />PAGE 37
<br />
<br />~J"-: "I'~ KEITH and SCHNARS, P.A.
<br />:; ~1 FLORlDAs 13j! LocAL FIRM
<br />---'
<br />
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<br />
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