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<br /> COQg' P' t5 .,,
<br /> 4 •,• n CONFLICT OF INTEREST
<br /> '_.. • City of Sunny Isles Beach
<br /> 4r
<br /> o 18070 Collins Avenue
<br /> 'ec9i'•,,coo ,'.' Sunny Isles Beach,FL 33160
<br /> '`•
<br /> o,so,''`' Telephone:(305)947-0606 Fax:(305)949-3113
<br /> CONFLICT OF INTEREST STATEMENT
<br /> 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 /> STATE OF FLORI ,
<br /> ,, n
<br /> COUNTY OF A6.c� .l'<.! — -4,c .
<br /> •0911 /00 067(K
<br /> BEFORE ME, the undersigned authority, personally appeared , who was duly sworn,
<br /> deposes, and states:
<br /> 18.1. I am the of
<br /> with a local office in and principal office in
<br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. described
<br /> as: . The Affiant has made diligent inquiry and provides the information contained in this
<br /> Affidavit based upon his own knowledge.
<br /> 18.3 The Affiant states that only one submittal for the above Bid is beingsubmitted and that the above named entityhas
<br /> no financial interest in other entitiesm
<br /> sub Itting Bids for the same project.
<br /> 18.4 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 pricingdata until the completion of negotiations if necessaryand
<br /> P 9
<br /> 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 /> 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 /> 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or
<br /> actively seeking an elected position with the City of Sunny Isles Beach.
<br /> 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 /> 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 /> immediately notify the City f Sunny Isles Beach.
<br /> Dated this ((/"1 day of " D V 4, r
<br /> AFFIANT Print or a Name and Title
<br /> •
<br /> YP
<br /> Sworn to and subscribed before me t ' day of v , 2019.
<br /> O Personally Known OR
<br /> '
<br /> O
<br /> Produced Identification Type of Ide• ..�.
<br /> I
<br /> NOTARY PUBLIC4' •�
<br /> STATE OF FLORIDA
<br /> �P;.,, LUCIAESTRELLA
<br /> 4';',, ,\ MY COMMISSION#GG 121005
<br /> '-•: e IRES;July 4,2021
<br /> ;�. _ EXP
<br /> '•f o �q"•A• Bonded Thru Notary Public Underwdlero
<br /> DECEMBER 28,2010 ,.„t,` _--_._.._-.
<br />
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