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CONFLICT OF INTEREST City of Sunny Isles Beach 18070 Collins Avenue � v Sunny Isles Beach, rL 33160 su-, p1t, Telephone: (305) 947-0606 Fax: (305) 949-3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112' Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OFFLORIDA COUNTY OF BEFORE ME, the undersigned authority, personally appeared who was duly sworn, deposes, and states: 18.1, | am the - of -with a local office in and principal office in 18.2 The above named entity is submitting aBid for the City of Sunny Isles Beach, Bid No. as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information con ed in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly mindirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended m otherwise ineligible from participation hn contract letting by any local, State, or Federal Agency. 18.6 Neither the anUty, nor its affi|iahoa, nor any one aeennia0od with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 1U'7| certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking on elected position with the City cf Sunny Isles Beach. 18.8 1 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. i8.Shn the event that o conflict of interest is identified in the provision of services, 1, on behalf of the above named entity, will immediately notify the City of Sunny Isles Beach. D�a 4tt th i s .12010.7 ,-,"AFFIANTf Print or Type Name'and Title Swomhoonduubacrbedbe�vemeth� 1-1*"' dayof 2016' pT- Personally Known -----DR [] Produced Identification �Type ofIdentification NDT&RY PUBLIC STATE QFFLORIDA NUNEZ 'ORMISSIori # E_ 111590 ires iul� 12 2015 m DECEMBER m.co10 5 uf1O