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Civil/Environmental Engineering 16-9 I ,,tON ti<F1 O n CONFLICT OF INTEREST ` City of Sunny Isles Beach 18070 tonins Avenue ar now Sunny Isles Beach,FL 33160 I x- Telephone:(305)947-0606 Fax:(305)949-3113 CONFLICT OF INTEREST STATEMENT I 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. I STATE OF FLORIDA COUNTY OF Miami-Dade BEFORE ME, the undersigned authority, personally appeared David Carter, CCM , who was duly sworn, Ideposes, and states: 18.1. I am the Senior Vice President of Atkins North America, Inc. with a local office in Miami, Florida and principal office in Tampa, Florida . I 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 12-04-02 described as: -Lardscapoa ainteReaceServices. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowiedge.f ontinuing Professional Architectural & Engineering Services Firms Only(CC NA) I18.3 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. I 18.4 Neither the Affiant nor the above named entity has directly or indirectly 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. II18.5 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. 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 Iimmediately notify the City of Sunny Isles Beach. Dated this 17th — .f April , 2012 . nal David Carter, CCM, Senior Vice President I AF I• •TII Print or Type Name and Title S 1p to and subscribed before me this 17th day of April , 2012 11....u..2 OY Personally Known OR Cl Produced Identification ;Type of Iden I iflcation�T''� -'�r+ crn e, NOTARY PUBLIC STATE OF FLORIDA I 1 ,.+t,4^344,,,, JULIA FORGIONE 1 1 / n.s Notary Public-Slate of Florida 0 1 t• . •= My Comm.Expires Nov 4, 2015 ' oeceeea 28.zolo daa Commission IEE 137344 1 .' O.. Bonded Through National HolmAssn. I 5of7 IPTIOPmelaryinone I0006077944.0512 Atkins I City of Sunny Isles Beach, RFQ No. 12-04-02