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<br /> °:"�r� NON - COLLUSION AFFIDAVIT
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<br /> City of Sunny Isles Beach
<br /> `or' 18070 Collins Avenue
<br /> c tw" c Sunny Isles Beach,FL 33160
<br /> "`cr +�"� Telephone:(305)947-0606 Fax:(305)949-3113
<br /> STATE OF {{C�4.�c-(y )
<br /> COUNTY OF C6dhrlx,I 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 /> 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 /> Stn,te,el-L►.t Tv, c
<br /> (Name of Corporation,Par(nership,Individual,etc.)
<br /> a, C 0 Ni p v"4 i 0 ,formed under the laws of K.Q,el NGhvl
<br /> (Type bf Business) (State)
<br /> of which he is l.kr c¢ h rt6Acio 1 dc.c- v
<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 /> AFFIANTS NAME AFFIANTS TITLE
<br /> TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day of 01'1 ,2017.
<br /> Personally Known )( or Produced Identification
<br /> Type of identification
<br /> (Affix seal here)
<br /> NOTARY PUBLIC(name printed or typed)
<br /> STEVE.RISTAU
<br /> NOTARY PUBLIC
<br /> Kentucky,State At Large
<br /> I.D.0 543406
<br /> My Commission Expires 101712019
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