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SJpNY istF <br /> COQ._t= •><as F, <br /> ``,;- NON - COLLUSION AFFIDAVIT <br /> rte ,f. : City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> if D''•F Loa`°' Sunny Isles Beach,FL 33160 <br /> c.",o. suµ'''� Telephone:(305)947-0606 Fax:(305)949-3113 <br /> STATE OF FLORIDA ) <br /> COUNTY OF DADE ) ) <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 /> The Goodyear Tire & Rubber Company <br /> (Name of Corporation,Partnership,Individual,etc.) <br /> a Tire & service repair formed under the laws of Ohio <br /> (Type 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 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 /> 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 /> 1 of 7 <br />