|
I
<br />I'
<br />1
<br />I"
<br />I,
<br />I,
<br />1 '
<br />1 ;
<br />1,
<br />J I
<br />]
<br />] I
<br />1
<br />1
<br />J
<br />I
<br />1
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I,
<br />I
<br />I'
<br />
<br />
<br />NON-COLLUSION AFFIDAVIT
<br />
<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 />
<br />STATE OF FLORIDA )
<br />COUNTY OF -o~ )
<br />
<br />The undersigned being first duly sworn as provided by law, deposes, and says:
<br />
<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 />
<br />The undersigned is authorized to make this Affidavit on behalf of,
<br />
<br />L \ Vs tvss';o.o.hs
<br />
<br />(Name of Corporation,[partnership,}lndividual, etc,)
<br />
<br />
<br />a, Ar0Itdu.r~/6rs1 flt.c.('ifl5, formed under the laws of
<br />(Type of Business)
<br />
<br />FL
<br />
<br />(State)
<br />
<br />of which he is ~. An~fl'IO P1e~ I Pn'(l,^-pc.f.
<br />(Sole Owner, Partner, President, etc.)
<br />
<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 />
<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 />
<br />f
<br />I'
<br />
<br />l="'~~IU~~
<br />AFFIANT'S NAME
<br />
<br />q',ind ~
<br />AFFIANT'S TITLE
<br />
<br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this .30 day of
<br />Personally Known ~ or Produced Identification
<br />
<br />kp(~L.
<br />
<br />,201J;
<br />
<br />Type of identification
<br />
<br />(Affix seal here)
<br />
<br />
<br />NOT ARY p,~.JJ3~8C (n me _ ~d)
<br />:J'" ,,"\'> MY COMMISSION # DO 968426
<br />It EXPIRES: March 7.2014
<br />.,~ ~ \l()l\iled 1001 8udgelllolWY Ser/ites
<br />;tqQkr;\"''''''
<br />
<br />DECEMBER 28,2010
<br />
<br />1 of 7
<br />
|