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1 111 Appendix Ill — Proposal Forms (continued) `'• CONFLICT OF INTEREST V �+ City of Sunny Isles Beach\1 •• 18070 Colas<ven:e '•\•'.1ou Sunny10es 0eact..Fl 33160 ...,v Teleptone'(309)47-0606 Fax 1303149-3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers nest dsclose 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 OF FLORIDA COUNTY OF Miami-Dade BEFORE ME, the undersigned authority, personally appeared Pablo Llerena , who was duy swan. deposes.and states: 18.1. I am the Partner of GLSC&Company,PLLC with a local office in Miami,Florida and principal office in Miami,Florida 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 15-12-01 described as: Landscape Maintenance Services. The Affiant has made dligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one subrnitral 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 AX1ant nor the above named entity has directly a incirectly entered into any agreement participated in any cdlusicn,or otherwise taken any action in restraints of free competitive pricing in connection with the entity's subnital 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 or otherwise inef4tile from participation in contract letting by any local,State.or Federal Agency. 18.6Neither the entity, nor its affiliates nor any one associated with them have any potential conflict of interest due to any other clients,contracts,or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or e actively seeking an elected position with the City of Sunny Isles Beach. 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 of Sunny Isles Beach. 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 immediatey notify the City of Sunny Isles Beach. Dat is 004 AC thy of v/ .201.5 acne 24 e AFFIANT Print or Type Name and Title 9wynn to and subscribedKnown hinOR �before me te day of nea�er .201% $ Personaly 0 Produced Identification :Type of Identification, / n NOTARY PUBLIC STATF � ORIDAwan N \ �'• .e d /AY COIWISSICN t FF 9007e3 EXPIRES:Norember 16,2010 I �M:�pd.� Badk Tb B4i1 Weary Sedge orct.sa 19.7010 Soil I PROPOSAL GL$C&COMPANY, PLLC RFP # 15-12-01 ' r_. nilieJ public accountants