Reso 2021-3182 - Laserfiche WebLink

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t yvHHr�trr CONFLICT OF INTEREST i •'T,� t`t9 fir= - •�•.• „ City af5unnyIsles Beach - `; 18070 Collins Avenue n_�1 ��.--• Sunny Isles each, FL 33100 TelepFmne:(305)9t7.0606Fax: (30S)9d4-31]3 prI , /t04' �ti CONFLICT OF INTEREST STATEMENT 'rhe owwcl or any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA C01JA1Ty OF _... BEFORE ME, the undersigned authority, personally appeared Krlty Fuentes who was duly sworn, deposes, and states: 1. I am the VPfSecretarylTreaSurer of DRC Emergency Services, LLC with a local office in w&sr Palm UpCh, IF Wida and principal office 1 in Galvegen. Texas_... • — ---- 7. The above named entity is 5ubmiltiAg a Bid for the City of Sunny Isles Beach, Bid No. 1B-04-02 _- described as Di-sm-cielirls managernern"ulspowlServices . The Affiant has made diligent inquiry and provides the inforrn8ti0n CUntaired in. this Affidavit leased upon his own knowledge - 3. The Affiant states that only one sulirnittal for the above Bid is being submitted and that :he above named entity has no financial interest 1n other entities submitting Bids Ear the same project. 4. Wither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any cotfusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid, this statement restricts the discussion of pricing data until the completion of negotiations if necessary and erteCutiVrl of t:re 0pntr8Ct for this project. 5. Neither the entity nor its affiliatesr nor anyone associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. G. Neither the entity, nor its affiliates, nor anyone associated with them have any potential Cor+ilict of interest due to any ,,her clients, contracts, or property interests for this project. 7- 1 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach, S. I certify that no member of the entIIy's•own ershIp of management, or staff has a vested Interest in any aspect of the City of Sunny Isles Beach. 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 immediately notify the City of Sunny Isles Beach, k-_ Datoo t'is L _ 2017 i Kristy Fuentes W/SecretwrylTreasurer AMAAMA14V V Print or Type -Name and Title Sworn to and subscribed before me this day of B Personally Known, OR 0 Produced Identification Type of Identification �a - NOTARY PUBLIC STATE OFf RI©A GARY , ORE RO HE • v 4 /// s of rotate of Louisiana, Bar Pio- 19550 My Commission is for life 119