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<br />
<br />NON-COLLUSION AFFIDAVIT
<br />
<br />0' sot-!
<br />
<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 />
<br />STATE OF FLORIDA
<br />COUNTY OF wn nJNJ
<br />
<br />The undersigned being first duly sworn as provided by law, deposes, and says:
<br />
<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 />
<br />The undersigned is authorized to make this Affidavit on behalf of,
<br />
<br />TA
<br />
<br />(Name of Corporation, Partnership, Individual, etc.)
<br />
<br />
<br />a,,<;O(' LN ~L( Se{\J; a: S
<br />(Type o(Business)
<br />
<br />, formed under the laws of
<br />
<br />FIOrr'{!)/t
<br />(State)
<br />
<br />of which he is
<br />
<br />B(;~(\
<br />
<br />Lec'J\
<br />(Sole Owner, Partner, President, etc.)
<br />
<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 />
<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 with 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 manner, 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.
<br />
<br />'\T^anA" E , ~S
<br />AFFIANT'S NAME
<br />
<br />j),'r t'c-hr ~ ,SB::UC 'rl-~
<br />AFFIANT'S TITLE I
<br />
<br />TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this iuH'day of
<br />Personally Known -V or Produced Identification
<br />
<br />~ICt~
<br />
<br />,20d
<br />
<br />Type of identification
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<br />'/1111 ZlC STr-.'ft. ~\,,,,,
<br />II"";,, II""'"
<br />DECEMBER 28, 2010
<br />
<br />
<br />10f7
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