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STATE OF FLORIDA i
<br />COUNTY OFH/4V J
<br />NON - COLLUSION AFFIDAVIT
<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 />The undersigned being first duly swom 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 />J- 610A 617-
<br />(Name of Corporation, Partnership, Individual, etc.)
<br />a (f�11(vtN�. &J formed formed under the laws of
<br />(Type of Business) (State)
<br />of which he is �l�i�%�%W
<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 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 Wth 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 mariner, 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.
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<br />AFFIANT'S NAME IANT'S TITLE
<br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this -12— day of ` 20015
<br />Personally Known or Produced Identification V-;
<br />Type Type of identification R Orit DA `Lb O'1%Jp,-- LAto-A, yL e
<br />(Affix seal here)
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<br />I IFFIVA
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<br />NOTARY PUBLI name punted pr typed)
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<br />DECEMBER 28, 2010 1 of 10
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