Reso 2021-3181 - Laserfiche WebLink

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CONFLICT OF INTEREST City of Sunny Isles Reach - �' 18070 Collins. Avenue Suany isles each, FL 33160 Telephone: (305) 947-oEo6 rzx! (3oi) 9aq-3313 o r .A Qy4 - - CONFLICT OF INTEREST STATEMENT The award of 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 Reath or its agencies_ STATE OF FLORIDA C6UNTY OF -OfNr BEFORE .ME, the undersigned authority, personally appeared �Q. i dtf fj'or f1I who was duly5worn, depa5es, and states: 1. 1 am the r _ of t` ith a local office in 0 and principal office in iW-2a W. r _-sz'0g--T-- Z. The above named entity is submitting a Sid for the City of Sunny Isles Reach, Bid No. 19 — --O—:k described as ±'"ra,�er �; S i`a4crt,e ram(_ The Affiant has made diligent inquiry and provides the information contained in this Affidavit Wed upon his own knowledge. 3_ The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entitiessvbmitting gidsforthe same project. 4, Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in cannection 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 execution of the Contract for this project. 5. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agertcy, 6, Neither the entity, nor its affiliates, not anyone associated with them have any potential conflict of interest duo to any other clients, contracts; or property interestsfor this project- ?. 1 certify that no member of the entity's ownership or management is presently applying far any employee position or actively seeking an elected position with the City of Sunny Isles Beach, 8, 1 certify that no member of the entityls ownership or management, or staff has a vested interest in any aspect of the City of 'Sunny Isles Beach, 5. In the event that a conflict of interest is identified in the provision of services, I, on behalf of tttip above named entity, will immediatelyP tify the City of Sunny Isles Beach. r [dated this .0.0 Ilk FFIANT Print or Type Name and Title worn to and subscribed before me this day of 004r ,'61a personally Ynown, Old 0 Prariuced Identification Th�pldentifc�atic�n �, ��..' tr'"�..1'""t�"��`t� NOTARY PUBLIiC STATE Of FLORIDA '` ' l naw�a, zam 5 of 10 �}� ,tir►wn