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0 <br /> ® et <br /> 2 , , l O <br /> 0 (_ a CONFLICT OF INTEREST <br /> - ; I- <br /> ,,, ,- <br /> I_ <br /> 0 <br /> ' City of Sunny Isles Beach <br /> 0, 13070 Collins Avenue <br /> ® `. I o>V:00, <br /> Sunny Isles Beach.FL 331o0 <br /> 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 /> e COUNTY OF Froward <br /> ® BEFORE ME. the undersigned authority, personally appearedwho was duly sworn, <br /> deposes,and states: <br /> ® 18.1. I am the Menacing Principal of <br /> ® Manuel Syna1st:ski Associates, LLC with a local office in <br /> Fort Lauderdale and principal office in <br /> Fort Lauderdale <br /> ® RFQ 12-04-02-0-2012/0c <br /> ® 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach. Bid No. 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 /> (0execution <br /> 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 /> ® 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or <br /> ;l actively seeking an elected position with the City of Sunny Isles Beach. <br /> ® 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 <br /> ® of Sunny Isles Beach. <br /> 0 <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 /> 2 <br /> ® Dated this 1✓ ay of PT(-\\ . 2012. <br /> ® Ma nue.✓, an and Title aY"5 <br /> Qr lnu.ftQ <br /> ® AFFIANT Print or Type Name and Title <br /> ® Swrn to and subscribed before me this V3 day of hen\ , 2012. <br /> F� Personally Known OR <br /> ® 0 Produced Identification : Type of Ider'fication <br /> ® NOTARY PUBLIC STATE OF FLORID(����711.C11MArrr7r'//, ��_-, , <br /> .5 4sSIONqrs'•.. <br /> ® = •VOA-k` .20i19o. <br /> •Q= <br /> RDD 9833&1 •o, <br /> ® �i.t 9 aa,eee eckei o` <br /> DEesusea73.2o10 �.... -9)...%/IHpAcltl p``�1-5 of 7 <br />