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,SUNNY)"", � CONFLICT OF INTEREST <br />s . City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles each, FL 33160 <br />,•� ,9 or J Telephone: (365) 947-0606 Fax: (305) 949.3113 <br />of 5�� ��d 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 U (Ja I - _Q_'�de <br />BEFORE ME, the undersigned authority, personally appearedNe ch -PA U, Vn t'C!{ aw <br />who was duly sworn, deposes, and states: <br />I amtheT_CC'SICleI'1't"' _ of <br />office in <br />in NP <br />+ lr'Ellld QM�, . with a local <br />.1 and principal office <br />2. The -above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. T' $ a�5" 0 ji <br />described as __ b�,winq nryl a ' The Affiant has made diligent <br />inquiry and provides the formation 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 />S. 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 />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 A day of I W U . 202&. <br />\)(A1e'nda N,C"( VAI +�ciU e,5ic, � <br />AFFIANT Print or Type Name and Title <br />Sworn to and subscribed before me this day of (Ay 20i'l. <br />❑ Personally Known, OR �y <br />0 Produced identification -Type of Identification N �„�CdS LiCtnGf <br />NOTARY PUBLIC STATE OF FLORIDA . L-t'�--�/ 05 <br />5 of 8 <br />Pr&S--hae 4U­�C Inn5f0r-I--,JdK1ing + r*C6Ve ry LC. <br />lzp-p � - 2 -3 -0S • 01 <br />