|
�O/VNNI'rs<Ff�m
<br /> 1 11 i NON - COLLUSION AFFIDAVIT
<br /> (lire ,� City of Sunny Isles Beach
<br /> •mss Qv'
<br /> Collins Avenue
<br /> '•FLOC'' o'` Sunny Isles Beach,FL 33160
<br /> or sus°' Telephone:(305)947-0606 Fax:(305)949-3113
<br /> STATE OF FLORIDA
<br /> COUNTY OF �7roWuM )
<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 /> (Name of Corporation,Partnership, Indi idual,etc.)
<br /> k
<br /> a, ,formed under the laws of ��2w
<br /> (Type of business) (State)
<br /> of which he is CLt'
<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 /> L 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 /> •\ t 41 (
<br /> AFFIANT'S NAME AFFIANT'S TITLE
<br /> TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day of J Q An Li ,200
<br /> Personally Known or Produced Identification Y
<br /> Type of identification J,4 Q(, tit T“,,o v mt,Z
<br /> (Affix seal here)
<br /> Q4. ,Z /b1
<br /> NOTART PUBLIC(name printed or typed)
<br /> f '
<br /> Renee Public State of Florida
<br /> Renee M Liber
<br /> My Commission EE150287
<br /> "?q fud Expires 12/13/201
<br /> DECEMBER 28,2010 1 of 10
<br />
|