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NON - COLLUSION AFFIDAVIT <br />STATE OF FLORIDA ) <br />COUNTY OF <br />The undersigned being first duly sworn as provided by law, deposes, and says: <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 Proposal. <br />10.2. The undersigned is authorized to make this Affidavit on behalf of, <br />p 0 a SIC <br />(Name of Corporation, Partnership, Individual, etc.) <br />a, , formed under the laws of TL <br />(Type of Business) (State) <br />of which he is mtbb l <br />(Sole Owner, Partner, President, etc.) <br />10.3. Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, <br />nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone <br />else to solicit favorable action for this Proposal by the City, also that no head of any department or <br />employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. <br />10.4. This Proposal is genuine and not collusive or a sham; the person, firm or corporation named <br />above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any <br />proposers or person, firm or corporation, to put in a sham Proposal, or that such person, firm or <br />corporation, shall refrain from proposalding, and has not in any manner, directly or indirectly, sought by <br />agreement or collusion, or communication or conference with any person, firm or corporation, to fix the <br />prices of said proposal or proposals of any other proposers; and all statements contained in the proposal <br />or proposals described above true; and further; neither the undersigned, nor the person, firm or <br />corporation named above in Paragraph 10.2, has directly or indirectly submitted said proposal or the <br />contents thereof, or divulged information or data relative thereto, to any association or to any member or <br />agent ther of. i <br />A AFFIANT'S TITLE <br />TAKEN, SWORN AND S BS RIBED TO BEFORE ME this day of 20�. <br />Personally Known or Produced Identification ; <br />Type of identification <br />((,off =O e)Notary Public State of Florida' <br />Greny Diaz <br />4c My Commission DD854372 NOTARY PUBLIC (name printed or typed) <br />Expires 04107/2013 <br />END OF SECTION <br />PAGE 85 OF 105 <br />PROPOSAL NO. <br />6k 19 <br />'R VIP - u- 11-0 1 -a -34L- <br />