HomeMy WebLinkAbout21. Non-Collusion Affidavit1P
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NON -COLLUSION AFFIDAVIT
City of Sunny Isles Beach
18070 Collins Avenue
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Sunny Isles Beach, FL 33160
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Telephone: (305) 947-0606 Fax: (305) 9493113
STATE OF FLORIDA
The undersigned being first duly sworn as provided by law, deposes, and says:
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
relied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid.
The undersigned is authorized to make this Affidavit on behalf of,
(Nam Corporation, Partnership, Indivt ual, etc.)
a,�Ie�x 04- Ljq�1i��� i formed under the laws of �1ZHC0
(Type of Business) (State)
of which he is i>Ao liW
(Sole Owner, Partner, President, etc.)
Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the
undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any
department or employee therein, or any officer of the City of Sunny isles Beach, Florida is directly interested therein.
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,
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
corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication
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
the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or
to any member or agent thereof.
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AFFIANT'S NAME AFFIANT'S TITLE
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this 7 day of
Personally Known 1.,/", or Produced Identification
Type of identification I_ 1 at c,C -re' J
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(Affix seal here)
NOTARY PLIC (name printed or typed)
o"��i DIANA MARIA FERRARA
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_�-Notary Public -State of Florida
Commission # HH 210965
,��� My Commission Expires
x'+1;111 December 26, 2025,
DECEMBER 28, 2010