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(15-05-01) Samson Oceanfront Park Improvements
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West Construction, Inc.
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Last modified
9/9/2015 4:33:14 PM
Creation date
9/9/2015 4:21:26 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Samson Oceanfront Park Improvements
Bid No. (xx-xx-xx)
15-05-01
Project Type (Bid, RFP, RFQ)
Bid
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sosnv 141F.: <br /> CONFLICT OF INTEREST <br /> City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> '4.\'.F`o' Sunny Isles Beach,FL 33160 <br /> o, sus'" 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 PALM BEACH <br /> BEFORE ME, the undersigned authority, personally appeared Martha A. Morgan , who was duly sworn, <br /> deposes, and states: <br /> 18.1. I am the President of <br /> West Construction, Inc. with a local office in Lake Worth, FL I and principal office in <br /> Lake Worth, FL <br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 15-05-01 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. <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 /> 18.7 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 /> 18.8 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 /> 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 /> 11•• this da o - .a September , 2010)5 <br /> „�G� 1� - sztr 1 art a • . •organ, 'resr.ent <br /> A F ANT — / Print or Type Name and Title <br /> Sworn to and subscribed before me this 9th day o Septem.- , 2010)1 <br /> yJ Personally Known Yes OR <br /> Produced Identification pe : ._"'� .c,i. ( / <br /> NOTARY PUBLIC STATE OF FLORIDA <br /> y RACaIIELdeAmrr I <br /> �� * MY00/A1SSlGliFFZfSi1 <br /> WIRES:.k1ne 9,2019 <br /> .144.c a Bated 1l n But el NOWY Seraef <br /> DECEMBER 28.2010 5 of 10 <br />
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