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, <br /> O <br /> oSUNNyas,,i <br /> CONFLICT OF INTEREST <br /> 0 ' City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> O =4�: '_.noR�,oi`,' Sunny Isles Beach,FL 33160 <br /> ',;oriioM,!— Telephone:(305)947-0606 Fax:(305)949-3113 <br /> O <br /> O CONFLICT OF INTEREST STATEMENT <br /> O The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must <br /> O 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 <br /> STATE OF FLORIDA <br /> 4) COUNTY OF Palm Beach <br /> OBEFORE ME, the undersigned authority, personally appeared Jerry Ingram, P.E. , who was duly sworn, <br /> ® deposes, and states: <br /> O 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 /> Q Raleigh.NC . <br /> O 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 /> O 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 /> O <br /> O 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 /> O 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in <br /> O 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 /> 5 execution of the Contract for this project. <br /> O 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from <br /> O participation in contract letting by any local, State, or Federal Agency. <br /> 5 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 /> Q 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 /> O 18.8 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 /> O of Sunny Isles Beach. <br /> Q 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 S a nny Isles Beach. <br /> 2012 <br /> O this th day of April j� <br /> Y.-- Jerry Ingram,P.E.,Senior Vice President/Principal Associate <br /> O A6/ANT Print or Type Name and Title <br /> �/ 2012 <br /> Li Sworn to and subscribed before me this 30th day of April , 34X <br /> O <br /> Personally Known X OR <br /> O Produced Identification ; Type of!den 'fication <br /> O /Cot,/Ylii, / 2 . --flQ <br /> .G <br /> Cvf Ac&Ii <br /> O NOTARY PUBLIC STATE OF FLORIDA / <br /> 0, 1 al - TAMMY LNARLOTT <br /> MY COMMISSION tl EE181709 <br /> IXP1RES January 19.2016 <br /> Qion 3930163 FbSatba.'Ss*t.ms <br /> O DECEMBER 25,2010 5 of 7 <br /> 0 <br />