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I `SUNNY,Jg I � � CONFLICT OF INTEREST VI- �1 ' I /: City of Sunny Isles Beach '1.-7,-:X. 1807e Beach, Avenue 33 ,10 '''lSunny Isles Beall, 160 ''o, ,. Telephone:(305)947-0606 Fax:(305)9493113 ' CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must I 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 OF FLORIDA ICOUNTY OF Palm Beach BEFORE ME, the undersigned authority, personally appeared John S . DePalma , who was duly sworn, deposes,and states: 1 18.1. I am the Vice President/Principal of McMahon Associates, Inc.with a local office in West Palm Beach, FL and principal office in Fort Washington, PA I 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, BidRFQ No.No. 12-04-02 described as: The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. Traffic Eng'g Transp Consulting I 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 or indirectly entered into any agreement, participated in I 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. I 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local,State,or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any Iother 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 actively seeking an elected position with the City of Sunny Isles Beach. I 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. I 18.9In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity,will immediately notify the City of Sunny Isles Beach. Date say of OY`l ,2010 I John S DePalma Vice President/Principal AF ' Pnn srTypeeName and Title wo and subscribed before me this 024; day of A-p'r^I ,201 Personally Known OR IO Produced Identification ;Type of Identification Ad)f'.t l I (�4/ 1: 412,f; NOTARY PUBLIC STATE OF FLORIDA / • I gam.°W. Notary Public State of Fianna Helen S Venetucci I c My Commission DD799632 t0,p, Expires 08/25/2012 cess en28.2010 5 of 7 I