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<br />NON-COLLUSIVE AFFIDAVIT <br /> <br />State of -f'Lo~ 1f'J/fr <br />)ss <br />County of Df<uWfrt::b <br /> <br />~Jfh01ES -t/5r2ff:ck <br />deposes and says that: <br /> <br />being first duly sworn, <br /> <br />(1) He/she is the Owner, Partner, Officer, Representative or Agent of the Bidder that <br />has submitted the attached Bid; <br /> <br />(2) He/she is fully informed respecting the preparation and contents of the attached. <br />Bid and of all pertinent circumstances respecting such Bid; <br /> <br />(3) Such Bid is genuine and is not a collusive or sham Bid; <br /> <br />(4) Neither the said bidder nor any of its officers, partners, owners, agents, <br />representatives, employees or parties in interest, including this affiant, have in any <br />way colluded, conspired, connived or agreed, directly or indirectly, with any other <br />Bidder, firm, or person to submit a collusive or sham Bid in connection with the <br />Work for which the attached Bid has been submitted; or to refrain from bidding in <br />connection with such W ork;or have in any manner, directly or indirectly, sought <br />by agreement or collusion, or communication, or conference with any Bidder, <br />firm, or person to fix the price or prices in the attached Bid or of any other Bidder, <br />or to fix any overhead, profit, or cost elements of the Bid price or the Bid price of <br />any other Bidder, or to secure through any collusion, conspiracy, connivance, or <br />unlawful agreement any advantage against the City of Sunny Isles Beach, or any <br />person interested in the proposed Work; <br /> <br />(5) The price or prices quoted in .the attached Bid are fair and proper and are not <br />tainted by any collusion, conspiracy, connivance, or unlawful agreement on the <br />part of the Bidder or any other of its agents, representatives, owners, employees or <br />parties in interest, including this affiant. <br /> <br />Sworn to and subscribed before me this <br />o fifrn ES +J =:;, t ff-E R- who <br /> <br />/Ir day of cVt""Cc!J11.6'f"A- 2004, by <br />IS personally known to me or has provided <br />as identification. <br /> <br /> <br />Notary Seal: <br /> <br />,~, Tina G Kwiatkowski <br />. ~ . MyCommlaaion 00178588 <br />~.,~ ExpIres JanuaIy 24. 2007 <br /> <br />I Request For Proposal Form <br /> <br />S~B <br />