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4SJNNv rs�er <br />CONFLICT OF INTEREST <br />_ t City of Sunny Isles Beach <br />1WOC ffmAvenue <br />F l O�'� v tit $UMnr Isles B8dC17, R 33160 <br />err ar wta F� Wephone: (305)947-MG Fmc @M 9493113 <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 e gr I — <br />BEFORE ME, the undersigned authority, personally appeared (JAE) �j��1NT Nftnjd 'yuho was duly sworn, <br />deposes, and states: <br />18.1. I am the turer of <br />t.(,G. with a local office in (re7PL and principal office in <br />U 2+ <br />182. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No24-Oa- 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 Afrient 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 ibrthe same project <br />18A 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 tatting by any local, State, or Federal Agency. <br />18.8 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 forthis 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 seeldng 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 of _ -1 day of <br />AFFiANT <br />Name and <br />Snrto and subscribed before me this day of'Ic nooxyPers <br />Produced <br />Known OR j 3 y _V z� o <br />Produced Identification : Type of Identification ��.�r. - �� . � ,/t.1 ��0 -^ <br />i CY/YlI .t <br />NOTARY PUBLIC STATE OF FLORIDAC<� <br />MARIA CCODARA <br />p -Notary Publio•state of Florida <br />�* corn 3810110 HH 2TO966 <br />My Commission Expires <br />December 26, 2W5 <br />oumam 28, 2010 <br />