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<br />NON-COLLUSIVE AFFIDAVIT
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<br />State of Fe 1J/111l~
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<br />Countyof /j//Owh11J
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<br />(/I(1)( !l /\_(0 ,v'71 ,1./(; ~/7U
<br />and says that:
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<br />being first duly sworn, deposes
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<br />(I) He/she is the (Owner, Partner, Officer, Representative or Agent) of the Bidder that has
<br />submitted the attached Bid;
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<br />(2) He/she is fully infOlmed respecting the preparation and contents of the attached Bid and
<br />of a II pertinent circumstances respecting such Bid;
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<br />(3)
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<br />Such Bid is genuine and is not a collusive or sham Bid;
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<br />(4) Neither the said bidder nor any of its officers, 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; 01' 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, linn, or person to Iix the price or prices in the altached Bid or of any othel' Bidder, 01'
<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 unlaw1l.1I agreement any
<br />advantage against the City of Sunny Isles Beach, or any person interested in the proposed Work;
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<br />(5) The price or prices quoted in the attached Bid are fair and proper and are not ta'inted by
<br />any collusion, conspiracy, connivance, or llnlawflllagreement on the pal1 of the Bidder or any
<br />other of its agents, representatives, owners, employees or panies in interest, Including this
<br />Affiant.
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<br />SIGNATURE OF AFFI~
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<br />vi- /1- X ;? /''t'? ,'" 'Ft.; -Vi- NI ;;)
<br />(Printed or Typed Legal Name of Affiant)
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<br />State of f!.oI<.,'tJJ1 County of B)oWJ912 D
<br />Sworn to and subscribed before me this ;?!f day of
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<br />Mill )ic tiMe;';) __
<br />Notary's Name Printed, Stamped or Typed
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<br />Personally Known: ~_ 01' Produced Identification _ Type:
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<br />liP!?; C-
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<br />, 2007 by
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<br />~~~".I~~........ . NA!~lolf ~,h;l.":IN
<br />~.~.i Notary Pu~"c ' Stale 01 Florida
<br />~:~~JMy CommtS3ron Expires Ju! 24. 2010
<br />....'f..'ff.rd'f.',. Commission t: DO 577274
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<br />Notary Seal:
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<br />Page 9 of9
<br />RFQ 07-03-0 I Engineering Srvs Bridge Revised (Addendum I ).doc
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