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NON - COLLUSION AFFIDAVIT STATE OF FLORIDA ) COUNTY OF �� ) The undersigned being first duly sworn as provided by law, deposes, and says: 10.1. This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be relied upon by said County, in any consideration which may give to and any action it may take with respect to this Proposal. 10.2. The undersigned is authorized to make this Affidavit on behalf of, (Name of Corporation, Partnership, Individual, etc.) • a, ry ' f. r , formed under the laws of (Type o Business) (State) • of which he is (Sole Owner, Partner, President, etc.) • 10.3. Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone • else to solicit favorable action for this Proposal by the City, also that no head of any department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. s • 10.4. This Proposal is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Proposal, or that such person, firm or • corporation, shall refrain from proposalding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person, firm or corporation, to fix the prices of said proposal or proposals of any other proposers; and all statements contained in the proposal • or proposals described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2, has directly or indirectly submitted said proposal or the contents thereof, or divulged information or data relative thereto, to any association or to any member or • agent thereof. dd Q • AFFIANT'S NAME AFFIANT'S TITLE TAKEN, SWORN AND SU CRIBED TO BEFORE ME this _ 3 day of ��>�, 204_0 Personally Known or Produced I ntification , • Type of identifications (Affix seal here) El 10 ?"►'l t f17 64 y 2- ZJ • NOTARY PUBLIC (name printed or typed) ;isr r EILEEN DOMINGUEZ • MY COMMISSION # DD 812645 EXPIRES: August 7, 2012 ' ' ... F oc' Bonded Thru Notary PubFc Underwr tars END OF SECTION PAGE 85 OF 105 PROPOSAL N0. •