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1/404 NY/xi <br /> �_ CONFLICT OF INTEREST <br /> ti /- City of Sunny Isles Beach <br /> i 18070 Collins Avenue <br /> '• r i oOac••' Sunny Isles Beach.FL 33160 <br /> ''o. .us 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 FLORIDA <br /> COUNTY OF ``[[ <br /> BEFORE ME, the undersigned authority, personally appeared/1411/1 M. &'Juiif I , who was duty sworn, <br /> deposes, and states: <br /> 18.1. I am the Executive Director of <br /> Southern Carpet Care d/b/a Elite with a local office in Fort I audardale FL and principal office in <br /> Elmont NY <br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. !TB 15-07-01 described <br /> as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this <br /> Affidavit based upon his own knowledge. (Citywide Custodial Services) <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 /> •b , C <br /> AFFIANT Print or Type Name and Title <br /> Sworn to and subscribed before me this 3 day of Aqi".4 , 20kr <br /> Personally Known OR Az i".4 ,�J �S�S <br /> Produced Identification ;Type of Identification S <br /> NOTARY PUBLIC STATE OF FtORIUA <br /> ® CATHY N.TURNER <br /> NOTARY PUBLIC,STATE OF DELAWARE <br /> MY COMMISSION EXPIRES AUGUST 30,201 <br /> DECEMBER 28.2010 5 Of 10 <br />