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<br />
<br />NON-COLLUSIVE AFFIDA VlT
<br />
<br />'-
<br />State of 'p"L C (2 I [). \ )
<br />
<br />County of hi" Iii -'V/\\)C)
<br />
<br />\~u 0'-1 r.{ D'( c S
<br />
<br />being first duly sworn, deposes
<br />
<br />and says that:
<br />
<br />(1) He/she is the (Owner, Partner, Officer, 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 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 cOllilection with the Work for which the attached Bid has been
<br />submitted; or to refrain from bidding in cOlmection with such Work; or have in any manner,
<br />directly or indirectly, sought by agreement or collusion, or communication,SJ.I:... conference with
<br />any Bidder, finn, 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
<br />advantage against the City of Sunny Isles Beach, or any person interested in the proposed Work;
<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 />Affiant.
<br />
<br />~~/:://~/7J
<br />SIGNA TUREDF AFFIANT
<br />
<br />. ---.:>
<br />\" \....It) ~1 Ji--{ (j l( 0 <:
<br />(Printed or Typed Legal Name. of Affiant)
<br />
<br />State of fi~,o "I,('l County of iju:'ll1;' - Jj~1: I.,:
<br />Sworn to and subscribed before me this 2,/ fit day of
<br />
<br />/;fPn /
<br />
<br />, 2007 by
<br />
<br />
<br />Lu>~'seal'-
<br />
<br />}&~~~~~~:0;~!';"'~~tT~g~~'~~~~~~~~'Y~~bT11
<br />1j1 :,~,':it ;"; 'vlY C. OI1f,:!!.',:c;.'" ,. ,.'. '_ t." 1,
<br />li..:'Y,:r:,i'~e5: ;:{)."'. ..'"'' ,..( .,r.}~/~CI Ii
<br />''''''l'-'..'......,., ""..k ;""",,, ""1'" l.1 " -v a I~
<br />,..-..~;;:.;'~;;;.-;;.~~~:.;~~~~~~~~~
<br />
<br />Personally Known:
<br />
<br />or Produced Identification
<br />
<br />Identification Produced
<br />
<br />fW
<br />
<br />Page 9 of9
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<br />RFO En>! Srvcs For Gov Infraslruculre 042407.Doc
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