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<br />NON-COLLUSIVE AFFIDAVIT
<br />
<br />State of
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<br />F \ Cor, (~;., )
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<br />County of \,\'\ \ 01"\' -I) Il...t .!:)
<br />
<br />'A \ \ C ; ," ,'~ .'\ ,\ G c." 1-.]" \ e "z...
<br />amI says that:
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<br />heing first. duly sworn, deposes
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<br />(1) He/4,-;;l is the. (Owner, Partner, Officer, Representative or Agent) or the: llidder that has
<br />submitted the attached Bid; Pee s ,de.'1-
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<br />(2) I Ie~is fully informed respccling the preparation and contenLo; of the attached Bid and
<br />of all pertinent circumst,UlccS respecting such Bid;
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<br />(3) Such Bid is genuine and is 1I0t n collusive or sham Bid;
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<br />(4) Neither the said bidder nor any or it,; officers, partners, OWllers. agcnLS. representatives,
<br />employees or parties in intercst, including this am ant, have in any way colluded. conspired,
<br />connived or agreed, directly or imlirectly, with any other Bidder. finn, or person to submit a
<br />collusive or sham Bid in cOllnection with the Work for which the attached Bid bus been
<br />suhmitted; or to refrain from bidding in connection ,,,'ith such Work; or have in any IlHIIUlCr,
<br />directly or indirectly, sought by agreement or collusion, or communication, or conference wiLh
<br />any Bidder, finn, or penson to fix the price or prices in the attached Bid or of any other Bidder, or
<br />to f1..'\ any overhead, profit, or cost elements of the Bid price or the Bid price of any other Bidder,
<br />or to securc through any collusion, conspiracy, connivance, or unlawful agrecmcnt any
<br />advantage agaill~t the City of Sunny Isles Beach, or any person intcrested in the proposed Work;
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<br />(5) The price or prices quoted in the attached Bid me fair llnd proper and arc not tainted by
<br />any collusion, conspiracy. connivance, or unlawful agreement on the purl of the Bidder or any
<br />other of its agents, rcprcsentatives, OWllers, cmployces or parties in interest, inclUll1ng this
<br />Affiant. r" I ')
<br />" !/..( (l' /;
<br />l:itt~Ul/ C,+f-i\ ;/ ,b~fv~4J.l \~"- Alicia Ana Gonzalez
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<br />-. SlGNATURi~ OF AI~FIAN-r': L'r (Plillted or Typed Legal Name of Affiant)
<br />
<br />State of FIt.>, , .:.~Collnty of 1'1" ;'~,J\ I -,lJ l,l~( "--
<br />SWOl11 to and ~ubscribcd before me this ) Lj-rL day of
<br />
<br />"
<br />l'~yr \
<br />
<br />, 2007 by
<br />
<br />{~ Lei';' AI,"
<br />
<br />( L '-
<br />\..;; C ',\ 2.-<:' \ r L-
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<br />"-... '~-1 1.'1\ "
<br />'-- .::nA t, ~ :, '" ,~ L-. " 1 t" "" z... f" <'".::. .=>
<br />Notary's Name Printed, Stmnpcd or Typed
<br />
<br />Notary Seal:
<br />
<br />Personally Known:
<br />
<br />Y..
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<br />..j~T:~,~ SUSANA 0 MESZAROS
<br />~..~~;.; MY r-0141~1S;~ION It OD6-43933
<br />-~1or ,... EXPIRES FAtlrllAry 26. 2011
<br />'.",
<br />401) )98.0153 flQ,tct"Nu'''''ySflrvtCtI 00f'I1
<br />
<br />or Produced Identification _ Type:
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<br />Page Y of l)
<br />RFQ 07-03-0 I Engineering Srvs Uridgc Heviscd (Addendum.!)
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