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<br /> ;,;, NON - COLLUSION AFFIDAVIT
<br /> :\ • City of Sunny Isles Beach
<br /> I 18070 Collins Avenue
<br /> `e- `• r.oouo•r: Sunny Isles Beach,FL 33160
<br /> Lb, sox 'x Telephone:(305)947-0606 Fax:(305)949-3113
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<br /> STATE OEF.LeRfUA )
<br /> ICOUNTY OFAIEelylltny ) )
<br /> I 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 /> 1 The undersigned is authorized to make this Affidavit on behalf of,
<br /> ?co logoss LLB
<br /> 1 (Name of Corporation,Partnership,Individual,etc.)
<br /> }
<br /> a, ��I mo t_ IJ� S,r- (ThSh1(�formed under the laws of �MAL nt..PPl Ih of ✓1 r sly 14—.n
<br /> ,/ ///1 (Type of Business) (State)
<br /> 1 of which he is Vi ca 4t s'Pt..r av /// J45e.+-.I' egaz44,0 r
<br /> (Sole Owner,Partner,/President,etc.)
<br /> INeither 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 /> I 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 102 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 /> I 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 /> ,'Illl WEI,/Ti> d e--- Esr>t,.ros /#pa rt.,1L.D no-.1
<br /> AFFIAN�AM _ — AFFIANTS TITLE /
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<br /> TAKEN,SWORN) SUBSCRIBED TO BEFORE ME this`( day of c) C4 ,►s+t6E12‘ ,200—
<br /> 1 Personally Known /l -or Produced Identification •
<br /> fill Type of identification
<br /> I (Affix seal here)
<br /> \lAe\2.-LlL M. t.S JES
<br /> NOTARY PUBLIC(name printed or typed)
<br /> 1 COMMONWEALTH OF PENNSYLVANIA �{ 1 Q 1c R_.- (tWY
<br /> .,.,tats seal (V� - _ _
<br /> Janette r inr,•:: •-:;,aty Public
<br /> I Oty of Pl2,i-..:.n ....,y County
<br /> My Commissu,:,1,,,:_ .c 2,2016
<br /> MB®ER,PB*LSYLVPNIA ASSO.3t : 3?NOTARI
<br /> 1 •
<br /> DECEMBER 28.2010 1 of 10
<br /> 1 ProGrass RFP No. 12-10-03 121
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