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CONFLICT OF INTEREST
<br />City of Sunny lsles Beach
<br />18070 Collins Avenue
<br />Sunny lsles each, F133160
<br />Telephone: (305) 947-0606 Fax: (305) 949-3113
<br />lamthe !.re Pe<iae,/rt- e1 T$z Par,ur
<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 lsles Beach or its agencies.
<br />STATE OF FLORIDA
<br />COUNTY OF Pn<,,u*,',\-
<br />BEFORE ME,the undersigned authority, personally appe.r"6 Por.r- + E Dk,n,t
<br />who was duly sworn, deposes, and states:
<br />7 Frt fl^" \ LL2-with a local
<br />office in Ivr r.
<br />in \.\\,{ d,t\^ar'
<br />2. The above named entity is submitting a Bid for the City of Sunny lsles Beach,Bid No. aa -l>- ot
<br />described as (;\wi,^c P,,,>..g :-k2Jia<< The Affiant has madediligent
<br />inquiry and provides the information cofit6ined 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 jf necessary and execution of the Contract for this project.
<br />8. I certify that no member of the entity's ownership or management, or staff has a vested interest in any
<br />aspect ofthe City of Sunny lsles Beach.
<br />9. ln the event that a conflict of interest is identified in the provision of services, l, on behalf of the above
<br />named entity, will immediately notify the City of Sunny lsles Beach.
<br />Dated this 5 day of -Ia-rrv*rv\,2 o>36{E*\a,*.ua,,- L . S-.-:n r*4 L.I Lat S VPcf (a-tcs
<br />AFF IANT Print or Type Name and tle
<br />5wol6 to and subscribed b
<br />E/ Personally Known, OR
<br />.'1^
<br />efore me this .<day of 5+**a<q-
<br />E Produced ldentification - Type of ldentification
<br />6rBr y-h^geu\ \{Bc#-
<br />a.20
<br />StBll(lrEEu HACX
<br />Notary Publi( - tt!t. of Florid!
<br />Emd€d through National tlotiry Atln,
<br />y Coftln. Erplrar 1,2021
<br />, HH 20852NOTARY PUBLIC STATE OF FLORIDA
<br />5of8
<br />0
<br />and principal office
<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 FederalAgency.
<br />6. Neither the entity, nor its affiiiates, nor anyone associated with them have any potential conflict of
<br />interest due to any other clients, contracts, or property interests for this pro.iect.
<br />7. I 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 lsles Beach.
<br />lr-
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