|
•
<br /> •
<br /> •
<br /> • susNY 4,,,
<br /> 0e ,...--754 rst
<br /> • - =So-4 CONFLICT OF INTEREST
<br /> • S): City of Sunny Isles Beach
<br /> ,y.-/ 18070 Collins Avenue
<br /> • se ift•no0 ` Sunny Isles Beach,FL 33160
<br /> • ter'o.1v,."'° Telephone:(305)947-0606 Fax:(305)949-3713
<br /> •
<br /> • CONFLICT OF INTEREST STATEMENT
<br /> •
<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 />_• COUNTY OF �f
<br /> • BEFORE ME, the undersigned authority, personally appeared iC i e-V4/ 4 as duly sworn,
<br /> • deposes,and states: L
<br /> • 18.1. I am the /7,P -^NT of
<br /> • ,Ar2C4/A7Z505y. ...- • with a local office inc )/n and principal office in
<br /> • 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid Nc/ 42 04-CAlescribed
<br /> • as: . The Affiant has made diligent inquiry and provides the information contained in this
<br /> • Affidavit based upon his own knowledge a /T/MU/NG , c65,a4.4c ARC/N72<LX/,/,MC..saw/co-5
<br /> /.404,1s ONt-`f
<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 /> the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and
<br /> •
<br /> execution of the Contract for this project.
<br /> ••
<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 /> •
<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 /> •
<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 /> •
<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 /> •
<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__ C9.7 day of__�,2-/e— 20
<br /> _ ir/O lea P2r3Z 7 T
<br /> • AFFIANT de _ /)'}P�rriint or Type Name and Title
<br /> • Sworn to . -d subscribed be ore me this ' day of , 2015-
<br /> �2f Personally Known OR
<br /> • O Produced Identification ;Type of Identification _
<br /> •
<br /> • NOTARY PUBLIC STATE OF FLORIDA •,•, • , I
<br /> •
<br /> • NOTARY PUBLIC-STATE OF FLORIDA
<br /> "" Jessica Morales
<br /> • Commission#EE044482
<br /> • ":„. ,/ Expires: NOV.22,2014
<br /> meal)TELiU ATL4 tIc 90 Vii G CO.,D"C.
<br /> • DECEMBER 28.2010 5 of 7
<br /> •
<br /> •
<br /> •
<br />
|