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RFQ # 26-07-01 CONTINUING PROFESSIONAL ARCHITECTURAL AND ENGINEERING CONSULTING SERVICES (CCNA)
<br />DISCIPLINE CATEGORY #4. ELECTRICAL ENGINEERS
<br />74
<br />6. CONTRACT FORMS
<br />&21)/,&72),17(5(67
<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 />&21)/,&72),17(5(6767$7(0(17
<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 _____________________________, who was duly sworn,
<br />deposes, and states:
<br /> I am the _________________________________________________ of
<br />__________________________________with a local office in _____________________________ and principal office in
<br />_____________________.
<br /> The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. ______________ described
<br />as: *ROGHQ6KRUHV6WUHHW/LJKWLQJ. The Affiant has made diligent inquiry and provides the information contained in this
<br />Affidavit based upon his own knowledge.
<br />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 />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 />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 />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 />I 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 />I 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 /> 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 this _________ day of _____________________________________, 20.
<br />_________________________________ _________________________________
<br />AFFIANT Print or Type Name and Title
<br />Sworn to and subscribed before me this _____ day of ______________________, 20.
<br /> Personally Known ________ OR
<br /> Produced Identification ________; Type of Identification _________________________
<br />__________________________________
<br />127$5<38%/,&67$7(2))/25,'$
<br />DECEMBER 28, 2010
<br />Bobak (Bobby) Shahnami
<br />Miami-Dade
<br />14, August
<br />President
<br /> Produced Identification ________; Type of Identification _________________________ on _________________________ on _____________________
<br />____________________________________________________________________________________________
<br />127$5<38%/,&67$7(2))/25,'$
<br />SGM Engineering, Inc.Miami, FLOrlando, FL
<br />RFQ26-07-01
<br />
<br />Bobak (Bobby) Shahnami
<br />In the event that a conflict of interest is identifie
<br />immediately notify the City of Sunny Isles Beach.
<br />Dated this _________ day of _____________________________________, 20
<br />_________________________________ _________________________________
<br />AFFIANT Print or Type Name and Title
<br />Sworn to and subscribed before me this _____ day of ______________________, 20
<br />14, August Dated this _________ day of _____________________________________, 2014, August Dated this _________ day of _____________________________________, 20
<br />14, August
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