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Nvrsi <br />CONFLICT OF INTEREST <br />6�. <br />n City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles each, FL 33160 <br />v . Telephone: (305) 947-0606 Fax: (305) 949.3113 <br />L� <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. 1 am the <br />office in <br />in <br />ren <br />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. <br />described as . The Affiant has made diligent <br />inquiry and provides the information contained in this Affidavit ha- knowledge. <br />3. The Affiant states th- - <br />entity has no financial intere <br />4. Neither the Affiant n <br />participated in any collusion, c <br />with the entity's submittal for <br />completion of negotiations if n <br />5. Neither the entity nor <br />ineligible from participation in c, <br />6. Neither the entity, nor i�, <br />interest due to any other clients, <br />7. 1 certify that no member <br />position or actively seeking an elec <br />8. 1 certify that no member o <br />aspect of the City of Sunny Isles Bea <br />ed and that the above narned <br />red into any agreement, <br />titive pricing in connection <br />pricing data until the <br />`ly suspended or otherwise <br />otential conflict of <br />plying for any employee <br />vested interest in any <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 day of <br />AFFIANT <br />Sworn to and subscribed before me this day of <br />❑ Personally Known, OR <br />❑ Produced Identification - Type of Identification <br />NOTARY PUBLIC STATE OF FLORIDA <br />5 of 8 <br />20 <br />Print or Type Name and Title <br />20 <br />