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0 <br /> 0 <br /> 0 <br /> O O,sus"IIs., <br /> ® 'r�(1CONFLICT OF INTEREST <br /> O • N _ City of Sunny Isles Beath <br /> ® o. teamColin Avenue <br /> • .0.x Bunny bleu Beads FL 33160 <br /> ® ,o, , Telephone:(335)947LL06 Fax:(305)9443113 <br /> ® CONFUCT OF INTEREST STATEMENT <br /> 4) The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must <br /> 0 <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 /> O STATE OF FLORIDA , �/\ <br /> ® COUNTY OF Brea..,„ - o.cto N� <br /> ® BEFORE ME, the undersigned authority, personally appeared i.(Sr II file _n4 t/ , who was duty swam, <br /> deposes,and slates: <br /> 0 18.1. I1 em the (41Owner of <br /> 0 <br /> Pt eh4e14-1)/ul Cen.s. Dry.-Ir with a local office in /171.arnr and principal office in <br /> fin. . <br /> 4) 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. I 1-0 Y-0 y described <br /> 0 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 /> 0 <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 /> 0 any collusion,or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for <br /> o 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 /> 4) 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 /> activey 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 /> ® 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 /> ® Dated this Z day ofn I Z <br /> // A flit Jr- 1/n-Mh,r<7L <br /> ® AFF �/ '� Print or Type Name and Title <br /> ® 4,24.49 , /z <br /> S�wym to and subscribed before me this aZ day of <br /> ® 8' Personally Known OR <br /> Produced Identification ;Type of Id Miification /' <br /> ® 4.44f ZZ;- — <br /> mit tcsK <br /> 0 NOTARY PUBUC STATE OF FLORIDA ✓✓✓ (/// <br /> 0 ,4 Hairy Public Stab of Ronda <br /> Zenaida Fernandez <br /> • I My Conanydorl FE57x <br /> 101 <br /> " <br /> O o E.rauaa ovri nail. <br /> ® CECOMISR al,2o11 5 of 7 <br /> 0 <br /> 0 <br /> ® Curtis + Rogers Design Studio RFQ 12-04-02 58 <br />