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VAN Y <br />d S 'f$\� <br />NON -COLLUSION AFFIDAVIT <br />U <br />City of Sunny Isles Beach <br />" 18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />STATE OF FLORIDA _ ) <br />COUNTY OF �� 1 <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 />— <br />i7Y <br />(Name of Corporation, Partnership, In ividual, etc.) <br />a,formed under the laws of <br />(Type of Business) (State) <br />of which he is <br />(Sole Owner, Paftner, 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 />t <br />01 <br />AFFIANT'S NAME AFFIANT'S TITLE <br />P <br />t <br />TAKEN, SWORN ND BSCRIBED TO BEFORE ME this day of 201 <br />Personally Known or Produced Identification <br />y <br />Type of identificationLA. 1111b <br />( �f l <br />(Affix seal here)) C ✓ (� �U <br />NOTARY PUBLIC (name printed or typed) <br />1 of 7 <br />2ANNEISHA MORRISON <br />.Notary <br />Public State of Florida <br />Commission # FF 900893 <br />N:2019 <br />1' OF„ ' <br />My Comm. Expires Oct 11, <br />1 of 7 <br />