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(11-04-03) Stormwater Catch Basin Cleaning
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Select Environmental Services
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Last modified
9/10/2015 9:52:11 AM
Creation date
5/26/2011 11:02:16 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Storm Water Catch Basin Cleaning
Bid No. (xx-xx-xx)
11-04-03
Project Type (Bid, RFP, RFQ)
Bid
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N C C <br />fih NON - COLLUSION 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 />STATE OF FLORIDA ) <br />COUNTY OF Hillsborough <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 />Select Environmental Services, Inc. <br />(Name of Corporation, Partnership, Individual, etc.) <br />a Corporation formed under the laws of Delaware <br />(Type of Business) (State) <br />of which he is Asst. Vice President <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 />AF S NAME <br />Ryan Perez, Asst. Vice President <br />AFFIANT'S TITLE <br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this 23rd day of May 2002011 <br />Personally Known XX or Produced Identification <br />Type of identification 4�Y,�B� RIKI COURTMAN <br />r °r �o MY COMMISSION #D0956249 <br />EXPIRES: JAN 27, 2014 <br />(Affix seal here) �-o rt m ^- rough 1st State Insurance <br />NOTARY PUBLIC (name printed or typed) <br />DECEMBER 28, 2010 1 of 7 <br />
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