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W SJ 014Y /g4 E� <br />�O @Y <br />NON - COLLUSION AFFIDAVIT <br />u'•. z <br />City of Sunny Isles Beach <br />�- 18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Of $U" � Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />STATE OF FLORIDA <br />COUNTY OF DQ d -e- <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 />(Narfie of Corporation, Partnership, WdividuN, etc.) <br />a, lj— & app M4 LA) A formed under the laws of .0t, wita <br />(Type of Business) (State) <br />of which he is etis • n ± <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 dr1ndirectlysubmitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or <br />to any member ,or agent;thereo . <br />AFFI ANT'S NAME AFFIANT'S TITLE <br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this VID dayf f V f ��, 201a <br />Personally Known J6 gNZ or Produced Identification <br />Type of identification <br />(A se1l MARIA VALDES <br />-' ?�• ° = Notary Public - State of Florida <br />My Comm. Expires Oct 25, 2015 <br />Commission # EE 121498 <br />NOTARY PUBLIC( name <br />DECEMBER 28, 2010 1 of 10 <br />or typed) <br />