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SVrNY•15�E, .. <br />Y <br />A. <br />NON - COLLUSION AFFIDAVIT <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />�ypc'APti °o� "� Sunny Isles Beach. FL 33160 <br />rr, o, suN - + Telephone: (305) 947.0606 Fax: (305) 949 -3113 <br />STATE OF FLORIDA ) <br />COUNTY OF Nl I <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 />relled upon by sold 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 />1 \ <br />(Name of Corporation, Partnership, Indlividual, etc) <br />�^ t <br />a\` Q <br />=L 11IA%s \Q �F.�Ct t(, formed under the laws of �t� (� C' <br />(Type of Business) (State) <br />of which he is �aW ( ? — �\ � C ' <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 />HT'S NAME AFFIANT'S TITLE <br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this day of 00_ <br />Personalty Known �° J or Produced Identification ; <br />Type of identification / ,-/ <br />(Affix seal here) <br />NOTARY PUBLIC (name printed or typed) <br />pu <br />Not Public Slate of Florida <br />a °4; <br />0S, "M, Duran <br />My Con',mission EE012243 <br />�'orf� °a �XpIre50712712014 <br />DECEMBER28, 2010 1 of 7 <br />