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Comtech - ITB 23-05-02
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(23-05-02) Golden Shores Pump Station Rehabilitation
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Comtech - ITB 23-05-02
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6/29/2023 11:28:53 AM
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O` SUNNY I fl Ff BI <br />CONFLICT OF INTEREST <br />V S <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />` Sunny Isles Beach, FL 33160 <br />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 FLOIR•Ij1q, m�- Dart, <br />COUNTY OF �f�1U <br />BEFORE ME, the undersigned authority, personally appeared IDA, Su" , who was duly swom, <br />deposes, and states: <br />18.1. I am the 'Pres of <br />(orn4tc.G1 Fnfith(fKinH with a local office in 794/7 .41fi 5:71hrr a,llsz and principal office in <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. TTd 2$ - es- 0Ascribed <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 />18.71 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 />Date thi day of JV44 <br />023. <br />U1,2 <br />AFFIANT <br />Print or Type Name and Title <br />Swp�n to and subscribed before me this <br />2gMday of KIL , 2023. <br />p' Personally Known <br />OR �t <br />1 <br />O Produced Identification <br />; Type of Identificado <br />NOTARY PUBLIC STATE OF FLORIDA <br />........... <br />ELIZABETH PAGE <br />Notary Public •State of F'odda <br />g <br />commission 0 HH 246701 <br />29. 2026 <br />a. r <br />My comm. Expires azar <br />3onced <br />through National votary Assr. <br />DECEMBER28, 2810 <br />71-6 - 23 a5 6 2 3) <br />
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