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<br />Ll-S Co('OUf I L-L-C-, d-/1Ja.. ~ l ~s \'c.. ~~(EXS <br />R"\=-? N.o. ~ \J - 0 4 - 0 1 <br /> <br />d.-tQ <br /> <br /> <br />NON-COLL USION AFFIDA VIT <br /> <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 /> <br />STATE OF FLORIDA <br />COUNTY OF ~ t:..... <br /> <br />The undersigned being first duly sworn as provided by law, deposes. and says: <br /> <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 /> <br />The undersigned is authorized to make this Affidavit on behalf of, <br /> <br /> <br />;:~o~co~~~~:rt~~ In1:&i~c.)C IA5Sl'c CA--he:(€ r5 <br />en Ai r~n'k- <br /> <br />a. (TY~~~~SS~ o-rJ , formed under the laws of (State) <br /> <br />of which he is <br /> <br />5~. V I' U2- V~('~ T <br /> <br />(Sole Owner, Partner, President. etc.) <br /> <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 /> <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 /> <br />~~ t'J- 1J LUJ 0 <br />AFFIANTS NAME <br /> <br />~. Ji'Le- ~,'JM\ <br /> <br />AFFIANTS TITLE <br /> <br />~ JLI)' ( <br />TAKEN, SWORN AND S~SCRIBED TO BEFORE ME this ~ day of t::p_ L <br />Personally Known /" or Produced Identification ; <br /> <br />, 2oJt! <br /> <br />Type of identification <br /> <br /> <br />(Affix seal here) <br /> <br />.....ii~r...... CONSUELO M. GARCIA <br />?r-~ ~\ MY COMMISSION. 00 em61 <br />~'~'<1; EXPIRES: April 6, 2013 <br />...'t.i!f.~~'" Bonded Thru Notary Public Underwriters <br /> <br />DECEMBER 28, 2010 <br /> <br />1 of 7 <br />