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<br /> <br />REQUIRED FORMS <br /> <br />NON-CoUtlStvE AFFIDA VIT <br /> <br />State of <br /> <br />Florida) <br /> <br />County of <br /> <br />Miami-Dade) <br /> <br />..:::>~ r?"\.VN\'u.,..p.. I ~~\O'erJ, being first duly sworn, deposes <br />and says that: <br /> <br />(1) Helshe is the (Owner, Partner, Officer, Representative or Agent) of the Bidder that has <br />submitted the attached Bid; <br /> <br />(2) Helshe 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, finn, or person to submit a <br />collusive or sham Bid in connection with the Work for which the attached Bid has been <br />submitted; or 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. ftrm. or person to fu 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, Florida, or any person interested in the <br />proposed Work; <br /> <br /> <br />\\\'11/1/1/1 <br />,,\\ ~C110N I./'~I <br />,"';;"~ ......... '11// ......, <br />~ ~ ....O?-POR-1..<"1Q'-:. <br />.. <:J . c; l'^. 00<'\ 0# <br />..C.). \'.\~- <br />=:::!E:. SEAL .~rn:' <br />_=:>- .z- <br />:. :z;. ~. 1983 : -f = <br />o#~. .::2- <br />.". tP-':,- ;<::-; . ~.... <br />~?...I.OR\\)~/~~ <br />"/ .... ..... ,..... <br />...... " <br />"'" \\' <br />1111/ 111\\\\ <br /> <br />'" <br />[ <br />'" <br />en <br />c <br />~ <br />"- <br />~ <br />c <br />" <br />~ <br />~ <br />'" <br />en <br />'" <br />'" <br />:I:: <br />'" <br />~ <br />'" <br />'" <br />.~ <br />V> <br />c <br />'" <br />t <br />~ <br />'" <br />'-' <br />11 <br />.~ <br />'0 <br />Q: <br /> <br />) The price or prices quoted in the attached Bid are fair and proper and are not tainted by <br />any collusion, conspira ,connivance, or unlawful agreement on the part of the Bidder or any <br />ther of its agents. r tatives, owners, employees or parties in interest, including this <br /> <br />..:>~ f?'.UN~~ , ~c.-.f"7"'\ <br />(Printed or Typed Legal Name of Affiant) <br /> <br />c; <br />"" <br />C> <br />0- <br />C> <br />.,; <br />Z <br />~ <br />"" <br /> <br />20 <br /> <br />. <br />