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r..O�.SJNNY FS(7
<br />NON - COLLUSION AFFIDAVIT
<br />v s
<br />City of Sunny Isles Beach
<br />r 18070 Collins Avenue
<br />LOS ��o,. Sunny Isles Beach, FL 33160
<br />T} OF SVN P� Telephone: (305) 947 -0606 Fax: (305) 949 -3113
<br />STATE OF FLORIDA J
<br />COUNTY OF
<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 />ne6ar La -,Doi r, Mic-
<br />(Namc{of Corporation, Partnersh p, In ividual, etc.)
<br />a, _ l L+g�i w4, formed under the laws of __ ��C1DI -
<br />(Ty e{of Business) (State)
<br />of which he is -----------------------------
<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 direc)y or indfrdctly�submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or
<br />to any membef�or a§ent then of?
<br />AFF NT'S NAME AFFIANT'S TITLE
<br />TAKEN, SWORN AND SUQSCRIBED TO BEFORE ME this -M— day of y� _ e.._____________, 20Q�.
<br />Personally Known ------ or Produced Identification -
<br />Type of identification
<br />(Af(psana {,here) MARIA VALDES /NTARY
<br />SP (FB,
<br />Notary Public - State of Florida P BLIC (name printed or typed)
<br />My Comm. Expires Oct 25, 2015
<br />Commission # EE 121498
<br />DECEMBER 28, 2010 1 of 10
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