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• <br /> • yv SUNNYi IJ(F, <br /> o" 's <br /> • ,u. _' CONFLICT OF INTEREST <br /> • t `v'% City of Sunny Isles Beach <br /> • ';➢= off'. 18070 Collins Avenue <br /> `=s..- '`,F I.01 .4.7 Sunny Isles Beach,FL 33160 <br /> • t�ur`iaw;,:t 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 /> 5 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 Palm Beach <br /> ® <br /> BEFORE ME, the undersigned authority, personally appeared Jerry Ingram, P.E. , who was duly sworn, <br /> deposes, and states: <br /> • 18.1. I am the Senior Vice President/Principal Associate of <br /> • Kimley-Hom and Associates. Inc. with a local office in West Palm Beach,FL and principal office in <br /> Raleigh.NC <br /> ® 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. RFQ 12-04-02 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 /> • 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 /> • 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 /> actively seeking an elected position with the City of Sunny Isles Beach. <br /> ® 18.8 1 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 /> 2012 <br /> • ` d this 30th day of April 24JAC <br /> ~/ Jerry Ingram,P.E.,Senior Vice President/Principal Associate <br /> • i'FFjlA Print or Type Name and Title <br /> • vv 2012 <br /> Sworn to and subscribed before me this 30th day of April , 'XX'XX <br /> • Personally Known X OR <br /> O Produced Identification ; Type of Identification <br /> ® 7Gury,n y / -<-Pc otA D <br /> • NOTARY PUBLIC STATE OF FLORIDA <br /> • t+'+ ' TAMMY I.SCARLOTT <br /> ® Jr <br /> MY COMMISSION It EE181709 <br /> ® EXPIRES January 19.2016 <br /> 1Mtl foeofe3 <br /> moratexinaweiteern <br /> ® DECEMBER 28,2010 5 of 7 <br /> 0 <br />