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<br />NON~COLLUSJVE AFFIDA VlT
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<br />State of
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<br />Floriq~..'_n_J
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<br />County of Ml fll'l1t:-'p,ude:,_J
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<br />....... Richm~~LM:tniGhiellQ..........__
<br />and says that:
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<br />being nrsl duly sworn. deposes
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<br />(1) He/she is the (Owner, Partner. Officer, Representative or Agent) of the Bidder that has
<br />submitted the attached Hid;
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<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:
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<br />(3) 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 ils officers. partners, owners, agents, representatives.
<br />employees or p,uties in interest, includ.ing this affiant, have in any ~/ay 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 witb the \~/ork for which the attilched Bid has been
<br />submitted; or to refrain from bidding in cOilnection with such Work; or have in any mann.er,
<br />directly or indirectly, sought by agreement or collusion. or conllntlnk~ation, or confcrenc(~ with
<br />any Bidder, finn, or person to fix the price or prices in the attached Bid or of .my other Bidder, or
<br />to fix any overhead, profit, or cost elements of the Bid price or the Bid price of any other Biclder,
<br />or to secure through any collusion, conspiracy. connivance, or unlawful agreement any
<br />advantage against, tbe City of Sunny lsles Beach, or any person interested in the proposed Work;
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<br />(5) '111e price or prices quoted in the attached Bid are fair and proper and are not tainted by
<br />any collusion. wflspirncy, connivance, or unlawful agreement on the part of the Bidder or any
<br />other of its agents, representatives, owners, ernployees or parties in interest, including this
<br />AfUanL
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<br />SIGNATURE OF AFFIANT
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<br />Rir-J19.rd Minh~hi ello
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<br />(Printed or Typed Lega,l Name of Affiant)
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<br />State of .........y,~::._County of L:Lnn--~; '{)Jc!(
<br />Sworn to and sub$crib(~d before me t.l-Jis ,n2.t.L day of _.C~::X;J5:.1___.......m'___' 200~'by
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<br />, "';': .'.~ t\ \))f f;. ..' ,. ",; ....
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<br />.2.~..>.......~''',:;......____ ' . ...,. V.::4~__.......mn.... .._..........................
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<br />\ /, "\"\' (A (,\.,,0{ ,\..i.1.. t....,: 'l )" 't\ C.)lr:mi$;;iO;l {i DD~iiNlU
<br />'N~;;~J;;; "N~~:m?~~~i~t~l:'S't;;~;'p'dtf; , .' :, '\;~~:\~\;~~:.:;.:::::,:.~f,.ll:'.".}
<br />... \t~ .. ,(0". :(. ~". < ,',;,\ ! .\,.. >~~
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<br />u...........--....-..,..
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<br />Notary Seal:
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<br />Pen;onally Known:
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<br />t.....
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<br />or Produced Identification _____m'
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<br />Identifkr:tion Produced
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<br />Pn.g~) 7 of 7
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<br />0'1.0..;.1.}2 (h;n l:.'JiS Sf':,:; u~!.' ii,...~~t~ Pk G:)1"t(~C flr~l (/~f({}
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