Laserfiche WebLink
I4ww <br />CONFLICT OF INTEREST <br />t City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />n` ° f so" ' Telephone: (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 FLORIDA <br />COUNTY OF <br />BEFORE ME, the undersigned authority, personally appeared (rel was duly sworn, <br />deposes, and states: <br />18.1. I am the LJ of <br />,P- Oe MA -C im! ,tr LLC,, with a local office in Conrft and principal office in <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No.described <br />as: Golden Shores Street Lighting. The Affiant has made diligent inquiry and provides the information contained in this <br />Affidavit based 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 />18.7 1 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 />Dated thj§ _ day of <br />AFFIANT <br />Print or Tvde Name and Title <br />Swor to and subscribed before me this day of ICfl, 1,—.phV <br />Personally Known OR <br />�l✓ Produced Identification ; Type of Identification s. �_� C - <br />NOTARY PUBLIC STATE OF FLORIDA <br />..'.w....,r.rr..i 7 <br />��R"YPVd DIANA MARIA FERRARA / <br />Z° S Notary Public -State of Florida <br />Commission # HH 210965 <br />+,;�o,�o;c My Commission Expires <br />December 26, 2025 <br />DECEMBER 28, 2010 <br />