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<br /> 0 „ANY gh,
<br /> '0',..'” CONFLICT OF INTEREST
<br /> iik;
<br /> Ito City of Sunny Isles Beach
<br /> 18070 Collins Avenue
<br /> tar tie� ''•f.o'`ov 4. Sunny Isles Beach,FL 33160
<br /> ''o, ..0.'~ Telephone:(305)947-0606 Fax:(305)949-3113
<br /> ialr
<br /> 0 CONFLICT OF INTEREST STATEMENT
<br /> tIr 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 /> City of Sunny Isles Beach or its agencies.
<br /> tip STATE OF FLORIDA..� /
<br /> ' COUNTY OF Oe -
<br /> BEFORE ME, the undersigned authority, personally appeared 4r/ci /VL//7PZ , who was duly sworn,
<br /> deposes,and states:
<br /> ler
<br /> F, 1'8,1. I pm ( the . (yes(O eK E of
<br /> 188. Ci ne - (2 t'l5 ( U,Ct10lA, £nC�with a local office in (v�k , Std 6,L" itf/� :4-6S and principal office in
<br /> A,,lG- F(. 331Y2i
<br /> tilts .p
<br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. ( 1 -0( -0I described
<br /> 4' as: The Affiant has made diligent inquiry and provides the information contained in this
<br /> Mr Affidavit based upon his own knowledge.
<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 /> er no financial interest in other entities submitting Bids for the same project.
<br /> iiii►
<br /> O18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in
<br /> 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 /> execution of the Contract for this project.
<br /> 11r 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from
<br /> E participation in contract letting by any local, State,or Federal Agency.
<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 /> other clients,contracts,or property interests for this project.
<br /> illy 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or
<br /> iitir actively seeking an elected position with the City of Sunny Isles Beach.
<br /> vitt 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 /> tit
<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 /> I* immediately notify the City of Sunny Isles Beach.
<br /> A* ,...--Dated this 1 Z k day of J'(4(e l .
<br /> „,- ,_ os 6,. e--1- re'tiPe'eri 1
<br /> �' FIA Print or Type Na a and`ITitle
<br /> NI,
<br /> Swore to and subscribed before me this Zt&day of Al /C 41
<br /> Personally Known OR I
<br /> Cl Produced Identification ;Type of Iden /__ ..• / '-
<br /> /. ,. ���•
<br /> `b NOTARY P BLI STATE OF FLORIDA
<br /> illy .0•4A�'s,. LINET SANCHEZ
<br /> • `,`t.. Notary Pub -State of Florida ( N--......_---• al
<br /> 1-ii Commission#GG 159830
<br /> :` My Comm.Expires Mar 4,2022
<br /> F o`f`ocfS
<br /> Bonded mrwgn Naxonal Notary Man.
<br /> vier DECEMBER 28,2010 5 of 8
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