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<br /> 411,
<br /> SUNNY is,
<br /> 4
<br /> Fr
<br /> � CONFLICT OF INTEREST
<br /> V•/J
<br /> lir; City of Sunny Isles Beach
<br /> 18070 Collins Avenue
<br /> IP iF f.0
<br /> 9, „ Sunny Isles Beach,FL 33160
<br /> ``'r,of suH.''O Telephone:(305)947-0606 Fax:(305)949-3113
<br /> 411110 CONFLICT OF INTEREST STATEMENT
<br /> 'i' The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must
<br /> disclose with their Bids,the name of any officer, director, partner, associate or agent who is also an officer or employee of the
<br /> I'' City of Sunny Isles Beach or its agencies.
<br /> liv STATE OF FLORIDA ��le
<br /> COUNTY OF
<br /> 41110+gay BEFORE ME
<br /> /
<br /> authority, personally appeared "6{r j A�/C//i,Z, , who was duly sworn,
<br /> the undersigned ,
<br /> deposes,and states:
<br /> 1rr of
<br /> 11�8,f1. I m the IJ eS(O eK
<br /> OW Ili Ci nt' - C tuk'f1,lCtibt^-, J-f -with a local office in Io4GLi SC4JI 6 Z A4/e .M'l4. and principal office in
<br /> a,ct G F(. 331'(a
<br /> lir
<br /> r ( ( -o�'Cl described
<br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No.
<br /> 4611, as: The Affiant has made diligent inquiry and provides the information contained in this
<br /> Affidavit based upon his own knowledge.
<br /> tor
<br /> 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has
<br /> 411, no financial interest in other entities submitting Bids for the same project.
<br /> V.
<br /> 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in
<br /> 41111, any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for
<br /> the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and
<br /> illy execution of the Contract for this project.
<br /> 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from
<br /> participation in contract letting by any local, State,or Federal Agency.
<br /> sillY
<br /> 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any
<br /> lir other clients,contracts, or property interests for this project.
<br /> 416111, 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or
<br /> illir actively seeking an elected position with the City of Sunny Isles Beach.
<br /> lir 18.8 I certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City
<br /> of Sunny Isles Beach.
<br /> lir
<br /> 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will
<br /> 411110 immediately notify the City of Sunny Isles Beach.
<br /> 7. 1!� day �ZU(�f -
<br /> low c-Dated this 1 of ��4,6 1 /'
<br /> A� -tom Z- iLc� es U to ,i /!'J/Or?/fJ
<br /> FIA NT Print or Type Na e and`:Title
<br /> r► /� ` � Zol`( ,
<br /> Swor to and subscribed before me this,'Ztday of �'(�` (c 4 ,.o
<br /> Personally Known OR ,�
<br /> O Produced Identification ;Type of Iden '
<br /> 4110 I. 41
<br /> MiliNFA
<br /> NOTARY P BLIC STATE OF FLORIDA
<br /> ,.•4;Rc'P,a.,, LINET SANCHEZ
<br /> _),F7 `FNotary Public-State of Florida ` `�-=
<br /> ' 4-" .- Commission#GG 159830
<br /> to r '; - My Comm Expires Mar 4,2022
<br /> O`,F, Bonded through Nanonal Notary Assn.
<br /> IOW DECEMBER 28,2010 5 of 8
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