|
SUNY Ij<F
<br /> , =
<br /> !,�
<br /> eNON - COLLUSION AFFIDAVIT
<br /> ® .tg.
<br /> 1i• City of Sunny Isles Beach
<br /> » u' r' 18070 Collins Avenue
<br /> D9,.FLOP'� -
<br /> 4
<br /> s' Sunny Isles Beach,FL 33160
<br /> c'''of %W. ',,v Telephone:(305)947-0606 Fax:(305)949-3113
<br /> STATE OF FLORIDA )
<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 /> CHK America, Inc
<br /> (Name of Corporation,Partnership,Individual,etc.)
<br /> a, Corporation California
<br /> formed under the laws of
<br /> (Type of Business) (State)
<br /> of which he is President .
<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 /> III 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; n " er the undersigned, nor the person, firm or corporation named above in Paragraph
<br /> 10.2,has directly or indirectly submitted said Bid or contents thereof,or divulged information or data relative thereto,to any association or
<br /> to any member or agent thereof.
<br /> '' 'Ztj
<br /> Frederick WoodPresident
<br /> AFFIANT'S NAME AFFIANT'S TITLE
<br /> TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day of ,201_.
<br /> Personally Known or Produced Identification ,•
<br /> Type of identification
<br /> (Affix seal here)
<br /> NOTARY PUBLIC(name printed or typed)
<br /> fa
<br /> 1 of 7
<br />
|