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<br />CITY OF SUNNY ISLES BEACH
<br />SECTION SEVEN: CONTRACT FORMS
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<br />NON-COLLUSiON AFFIDAVIT
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<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
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<br />STATE OF FLORIDA
<br />COUNTY OF Broward
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<br />The undersigned being first duly sworn as provided by law. deposes, and says:
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<br />a, engineering firm
<br />(Type of Business)
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<br />, formed under the laws of Florida
<br />(State)
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<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.
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<br />The undersigned is authorized to make this Affidavit on behalf of,
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<br />Mark Tomczyk, P.E.
<br />(Name of Corporation, Partnership, Individual, etc.)
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<br />of which he is Vice President
<br />(Sole Owner, Partner, President, etc.)
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<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,
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<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 there f,
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<br />Vice President
<br />AFFIANT'S TITLE
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<br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this L day of ~J'Ohaz.
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<br />Personally Known ./ or Produced Identification
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<br />Type of identification
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<br />MARLENE PINNOCK
<br />MY COMMISSION # DO 735215
<br />EXPIRES: February 13,2012
<br />.~onded Thru Nolary Public Underwmers
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<br />~.I~~l~ KEITH and S~HNARS, P.A.
<br />". !.1;:;'~1 FWRIDAs 13J,r-lOCAL FIRM
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<br />P AG E 66
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<br />RFP#11-11-02
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