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NON.COLLUSION AFFIDAVIT <br />Ciiy of Sunny lsles Beach <br />18070 Collins Avenue <br />Sunny lslgs Bsach, FL 33160 <br />Telephoner (305)947-0606 Fax (305) 949-3113 <br />STATE OF FLORIDA ) <br />couNTY oF _) <br />The undersigned being first duly swom as provided by law, deposes, and saysl <br />This Affidavit is made with the knowledgo and intent that it is to be filed with the City of Sunny lsl€s Beach City Commission and that it will be <br />rolied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid. <br />The undersignod is authoriz€d to make this Affidavit on beh€lfof, <br />a, Contrator , formed under the laws of Florida <br />(Type of Business)(Stato) <br />ofwhich he is President <br />(Sole Owner, Partner, President, etc.) <br />Neither the undersigned nor any person, firm, or corporation named in above Paragtaph 10.2, nor anyone else to the knowledge of the <br />undersigned, have themselves solicited or employed anyone elso to solicit f€vorable action fof thls Bid by the City, also that no head of any <br />departmont or employee therein, or any oflicer ofthe City of Sunny lsles Beach, Florida is dlrectly Interested thereln. <br />This Bld is genuine and not collusive or a sham; the person, firm or corporation namod above in Paragraph 10.2 has not colluded, conspired, <br />connived or agaood directly or indlrectly with any prcposers or person, firm or corporation, to put In a sham Bid, or that such pe6on, firm or <br />corpo€tion, shall reftain trom Bidding, and has not in any manner, direcuy or indirectly, sought by agreement or collusion, or communication <br />or conference wlth any porson, firm or comoration, to fix the prices of said Bid or Bids of any othor proposors; and all statemonts contained in <br />tlon named above In Paragraph <br />the Bid or Bids described above true; and further: neither the undersigned, nor the person, firm or corporbe lhereto, to any assoqiation or <br />President <br />AFFIANT'S TITLE <br />TAKEN, SWORN AND SFSCRTBED TO BEFORE ME this _lL day of f)e.emher , 2001.6 <br />Persorally Knowr -Vl or Produced lderlitication <br />-: <br />Type of identification <br />(Affix seal here) <br />{Name of Corporatlon, Partnership, lndivldual, etc.) <br />DECEMBER26,20lO 1of10