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NON - COLLUSION AFFIDAVIT
<br />City of Sunny Isles Beach
<br />�➢ aP•. 18070 Collins Avenue
<br />tiF FLOP\ 05` Sunny Isles Beach, FL 33160
<br />or So ' Telephone: (305) 947 -0606 Fax: (305) 949 -3113
<br />STATE OF FLORIDA )
<br />COUNTY OF M iP W�
<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 lake with respect to this Bid.
<br />The undersigned is authorized to make this Affidavit on behalf of,
<br />Orc. , td IAan Lan45c W 44'sa o 5 , �p -
<br />(Name of Corporation, Partnership, Indillvidual, etc.)
<br />a, & Y p0 rat -Ho it formed under the laws of 9 r, dA
<br />(Type of Business) (State)
<br />of which he is Pile S1 Gcx
<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 />Pre 0.44
<br />AFFIANT'S NAME G , Cry L AFFIANT'S TITLE
<br />TAKEN, SWO AND 7SUB RIB ED TO BEFORE ME this `/ day
<br />Personally Known r Produced Identification ,
<br />Type of identification
<br />(Affix seal here)
<br />Patricia Vallejo
<br />CORi'd muI i # DD907261
<br />;9. .440;; JCP!RLS: JUL, 14, 2013
<br />AWW. AARON NOTARY corn
<br />�2n /—'L,
<br />DECEMBER 28, 2010 1 of 10
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