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N"V/S<FJ CONFLICT OF INTEREST <br />A. <br />t= City of Sunny Isles Beach <br />t r # 18070 Collins Avenue <br />Sunny Isles each, Ff 33160 <br />�.9 ori P Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />bF FIORD sw <br />C,TY OF SOn FNO <br />CONFLICT OF INTEREST STATEMENT <br />The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers <br />must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or <br />employee of the City of Sunny Isles Beach or its agencies. <br />STATE OF FLORIDA <br />COUNTY OF <br />BEFORE ME, the undersigned authority, personally appeared <br />who was duly sworn, deposes, and states: <br />1. I am the <br />office in f-WiC <br />in Ift— <br />of S -f y -e Cc,)ev-�t�b, jv1( with a local <br />and principal office <br />2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. '22 Z - 03 -- U <br />described as C�A't' VrW f4`1 26? -IL (Z.Ei��-�L 1,IiA �IftC7(%+v Al- . The Affiant has made diligent <br />inquiry and provides the information contained in this Affidavit based upon his own knowledge. <br />3. The Affiant states that only one submittal for the above Bid is being submitted and that the above named <br />entity has no financial interest in other entities submitting Bids for the same project. <br />4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, <br />participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection <br />with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the <br />completion of negotiations if necessary and execution of the Contract for this project. <br />5. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise <br />ineligible from participation in contract letting by any local, State, or Federal Agency. <br />6. Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of <br />interest due to any other clients, contracts, or property interests for this project. <br />7. 1 certify that no member of the entity's ownership or management is presently applying for any employee <br />position or actively seeking an elected position with the City of Sunny Isles Beach. <br />8. 1 certify that no member of the entity's ownership or management, or staff has a vested interest in any <br />aspect of the City of Sunny isles Beach. <br />9. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above <br />named entity, will Immediately notify the City of Sunny isles Beach. <br />Dated this <br />��� Sr day of '" �Gtl(L*N , 20 Z,!Z- <br />AFFIANT Print or Type Name and Title <br />5� <br />Sworn to and subscribed before me this day of �4 6 /1-455- 11 .20 ZZ- <br />❑ Personally Known, OR <br />Produced Identification - Type of Ventification 1- 60 rZ.' i4e 0 -z -,g �'� 6615 e. <br />NOTARY PUBLIC STATE OF FLORIDA <br />ep NORBERTO J PEREZ•80RROT0 <br />Notary Public State of Florida <br />5 $���'� Commission # HH 008101 <br />°f �' M Camm, <br />Y Expires Jul 14, 2024 <br />