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(16-09-02) HVAC Government Center
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Jorda Enterprises
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Last modified
1/10/2017 3:02:35 PM
Creation date
1/10/2017 2:03:15 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
New HVAC Chiller Systems For Government Center
Bid No. (xx-xx-xx)
16-09-02
Project Type (Bid, RFP, RFQ)
Bid
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STATE OF FLORIDA <br />COUNTY OF M i4-vy s D7 ea— <br />NON-_C_O_LLUSION AFFIDAVIT <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947.0606 Fax: (305) 949-3113 <br />The undersigned being first duly sworn as provided by law, deposes, and says: <br />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 <br />relied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid. <br />The undersigned is authorized to make this Affidavit on behalf of, <br />(Name of Corporation, Partnership, Individual, etc.) 1r rar <br />a, 4 formed under the laws of P LADOLS C2& <br />(Type of Business) (State) <br />of which he is _sollp. <br />(Sole Owner, Partner, President, etc.) <br />Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10,2, nor anyone else to the knowledge of the <br />undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any <br />department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. <br />This Bid is genuine and not collusive or a sham; the person, firm or corporation named above In Paragraph 10.2 has not colluded, conspired, <br />connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or <br />corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication <br />or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in <br />the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph <br />10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or <br />to any member or agent thereof. <br />w► w ® " <br />AFFI T'S AME AFFIANT'S TITLE <br />7 <br />TAKE AND SUBSCRIBED TO BEFORE ME this day of J/1/00-4 /00-4 k cif , 2091 <br />Personally Known or Produced Identification <br />Type of identification <br />(Affix seat here)I�JA <br />RY PUBLIC (?name printed ortyped) <br />JOSE ANTONIO ALONSO <br />Commission # FF 083252 <br />Expires February 22, 2018 <br />8.ndud Tt. Troy fan Insarame 800385.7019 <br />DEcEmam 28, 2010 1 of 10 <br />
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