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<br /> 1p` „ CONFLICT OF INTEREST
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<br /> City of Sunny Isles Beach
<br /> 18070 Corrins Avenue
<br /> ". •no'-' ,` Sunny Isles Beach,FL 33160
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<br /> o. .v+'_,0 Telephone:(305)947-0606 Fax:(305)949-3113
<br /> CONFLICT OF INTEREST STATEMENT
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<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 /> I STATE OF FLORIDA
<br /> COUNTY OF Miami-Dade
<br /> BEFORE ME, the undersigned authority, personally appeared David Carter, CCM , who was duly sworn,
<br /> I deposes, and states:
<br /> 18.1. I am the Senior Vice President of
<br /> Atkins North America, Inc. with a local office in Miami, Florida and principal office in
<br /> ITampa, Florida .
<br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 12-04-02 described
<br /> as: - and66ape-MainteaaaeeSera4ees. The Affiant has made diligent inquiry and provides the information contained in this
<br /> Affidavit based upon his own knowledge.Continuing Professional Architectural & Engineering Services Firms Only(CCNA)
<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 /> I 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 /> I18.5 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 /> I 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 /> I18.8 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 /> I 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 noti the City of Sunny Isles Beach.
<br /> Dated this 17th .f April , 2012
<br /> ©/IF David Carter, CCM, Senior Vice President
<br /> AF, TIF Print or Type Name and Title
<br /> ;99x-to, and subscribed before me this 17th day of April , 2012
<br /> I Personally Known OR
<br /> ;
<br /> 0 Produced Identification Type of Iden ification
<br /> NOTARY PUBLIC STATE OF FLORIDA
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<br /> Isdhaidhailialease
<br /> ;'„',.,-, JULIA FORGIONE
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<br /> I 0 p, t s Notary Public-Slate of Florida
<br /> s• a My Comm.Expires Nov 4.2015 '
<br /> d` Commission•EE 137344 5 of 7
<br /> DECEMBER 7e,zolo '.,',..or.ld Bonded Through National Notary Assn.
<br /> I0006.027944.0612 nreneurrirenrirelle Atkins I City of Sunny Isles Beach, RFQ No. 12-04-02
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