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ID Susst/jr- <br /> err. ' NON - COLLUSION AFFIDAVIT <br /> I V 1., 1H <br /> City of Sunny Isles Beach <br /> •, =y o�s+ eau 18070 Cale Avenue <br /> t, •srosv Sunny Isles Bt FL 33160 <br /> es, •O.is.,•e Telephone:(305)947-0606 Fax(305)9143113 <br /> 1 — <br /> STATE OF FLORIDA <br /> COUNTY OF <br /> The undersigned being first duty swum as provided by law,deposes.and says: <br /> This Affidavit is made with the knowledge and intent that it is to be tied with the City of Sunny Isles Beach City Commission and that it with be <br /> retied 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 /> (Name of Corporation.Partnership,Individual,etc.) <br /> a, formed under the laws of <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 tamable 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 Sorry Isles Beach,Florida is directly interested therein. <br /> This Bid is genuine and not collusive or a sham;the person,fum or corporation named above in Paragraph 10.2 has not colluded,conspired, <br /> connived or agreed directly or bdvectly 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 tlrereof 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 <br /> Personally Known or Produced Identification <br /> Type of identification <br /> (Affix seal here) <br /> NOTARY PUBLIC(name printed Or typed) <br /> Cement 28 2010 I of 7 <br />