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<br /> NON - COLLUSION AFFIDAVIT
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<br /> .. -s..,...„,,. . • City of Sunny Isles Beach
<br /> •/y9 /pl QP••• 18070 Collins Avenue
<br /> '"f •F OR' 0 4: Sunny Isles Beach,FL 33160
<br /> c'r'o r sus '� Telephone:(305)947-0606 Fax:(305)949-3113
<br /> STATE OF FLORIDAnnnn )
<br /> COUNTY OF l7\1.1 A )
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<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 /> (1161-1c CAA 0\cc VB.\blIJG /coff Lac
<br /> (Name of Corporation,Partnership, Individual,etc.) G
<br /> a,vt0 k(.3 Ci t`AMQF�11,formed under the laws of , -Og—k CA
<br /> (Type of Business) (State)
<br /> of which he is Th\'(1.1Z•C01(l. C .I" ONP%(L,N.-\\ 1.)5.
<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 /> too�any
<br /> ,member or agent thereof.
<br /> /' Y ►7 ` Ver/
<br /> AFFIANT'S NAME AFFIANT'S TITLE
<br /> TAKEN,SWORN AND SUBSCRIBED (,p
<br /> TO BEFORE ME this l hday of rP\k L_ ,201. - .
<br /> •
<br /> ` SU
<br /> Personally Known V or Produced Identification ,
<br /> Type of identification 5"-ed,,
<br /> (Affix seal here) J C (c. ,-
<br /> _______
<br /> NOTARY PUBLI (name printed or typed)
<br /> ,:a' 4, ,_ STACEY C SNEDIKER
<br /> y._ ` MY COMMISSION#GG028051
<br /> '•'.'+a;- EXPIRES September 08,2020
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