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tANY <br />NYI$, <br />�f. CONFLICT OF INTEREST <br />v. x <br />City of Sunny Isles Beach <br />` 18070 Collins Avenue <br />ykr�g v� <br />V. ` Sunny Isles Beach, FL 33160 <br />$UN hTelephone: (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 FLORIDAr� <br />COUNTY OF R,e -, *\-A <br />BEFORE ME, the undersigned authority, personally appeared Jrf_+ `, Jf,0^^-VV�who was duly sworn, <br />deposes, and states: <br />18.1. •I am the C • o of <br />�-`Z 1; LA .mss . Lv -x with a local office in 1 avte t (- ` and principal office in <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, RFQ No. described <br />as: RFP Event Rides. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based <br />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 />no financial interest in other entities submitting 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 pricing data until the completion of negotiations if necessary and <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 />18.81 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 of Sunny Isles Beach. <br />Dod this a7- day of /���• / 2021. <br />AFFIANT Print or Type Name and Title <br />Sorn to and subscribed before me this day of x -a\ 2021. <br />f Personally Known OR <br />O Produced Identification ; Type of Identification <br />NOTARY PUBLIC STATE OF FLORIDA <br />DECEMBER28,2010 <br />