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.any i!r► <br />O` ` f <br />NON -COLLUSION AFFIDAVIT <br />y' i <br />City of Sunny Isles Beach <br />18070 Cottrns Avenue <br />• . �. v'`Ya Sumy Wes Beach, :t 33160 <br />Weahnne 305I941-0606 Fox,(3051849-51113 <br />STATE OF FLORIDA ) <br />COUNTY OF Mrriit,r We <br />The unders fined being first duly sworr as provided by law, deposes. and says <br />This Affidavit is made with the knowledge and intent thal it rs to be fried with the City o1 Sunny Isles Beach City Commission and tnat i1 w II be <br />relied upon by said County, in any Consideration which may give to and any action it may take N in respec''o this Bid. <br />The undersigned is authorized to make this Affidavil on behall of, <br />T LI -`QCk"VV\, }Iii <br />(Name of Corporation. Partnership. Individual., etc.) <br />,I-- I � rY„�[ Ci -4C I(c i�- forted under the laws of C L <br />(Type of Business) (Stale) <br />sye I <br />-� <br />of Which M is 1 r1 C i Cir ;t -k <br />- <br />of <br />Owner: Partner, President etc.) <br />Neither the undersigned nor any parson, firm., or corporation nanted above nor anyone else to the knowledge of the undersigned. have <br />themselves solicited or employed anyone etre to soiicrt favorable action for this Bid by the City, also that no head of aly department or <br />employee therein, or any officer of the City of Sunny Islas Beach. Flonda is directly interested therein, <br />Ibis Bid is genuine and not collusive or a sham, the person, firm or corporation named above has not colluded, conspired.. connived or agreed <br />dfrecily or Irxfrrectfy wth any proposers or person, firm or Corporation, to pal in a sham Bid, or that such person, firm or corporation, shall <br />refrain from &riding, and has not in any manner, directly or mclireetly, sought by agreement or collusion, of Communtcabon or conference w 111 <br />any person, firm or cofporat,on, to fix the prices of said Bd or Bids of any other proposers: and all statements conte neo in the Bid or Bids <br />described above true. and further; neither the undersigned, nor the person. firm or corporation named above has directly or indirectly <br />submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent <br />thereof_ <br />....)�C�15P <br />AFFtANT'S NAME <br />AFFIANT"$ TITLE <br />TAKEN, S'WCHN AND SUBSCRIBED TO BEFORE MB this day of ( 20 .E <br />Personally Known or Pro��dd(uced IIddentiftcabon L� <br />Type of identrfcabon,�i��%fi� }�f��J S L�CCnSC <br />lAffix seal here) <br />El <br />fliTt7 J DEAE[.SORRpTO NO Y PURL are pant or yped) <br />Public • Site 0f Flondit <br />miWontHm00810tm Erspiritr Jt l 14, 1014 <br />1 of 8 <br />