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S,,ANY rs <6fe� <br />NON - COLLUSION AFFIDAVIT <br />* <br />•' <br />City of Sunny Isles Beach <br />r <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />or sus 'NV <br />Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />STATE OF FLORIDA de— <br />The ) <br />COUNTY OF D2 ) <br />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 />�e VlC'es <br />(Name of Corporation, Partnership, Individual, etdf) <br />a, l_lo formed under the laws of to&6 <br />(Type of Business) (State) <br />of which he is Z&/- " I—Ulri <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 />Xo�" '4j/16� prli�� d e <br />AFFIANT'S NAME <br />AFFIANT'S TITLE <br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this Z-)n oday of " 4-Y , 2001. <br />Personally Known _ <br />Type of identification <br />or Produced Identification r <br />-FgL- <br />(Affix seal here) <br />CARLOS R. PERNIA NOTARY PUBLIC (n me rinted or typed) <br />°.r MY COMMISSION # DD 741526 <br />a EXPIRES: January 7, 2012 <br />sif; wd ' Bonded Th. Notary Public underwriters <br />DECEMBER 28, 2010 1 of 7 <br />