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„tan ;J1 <br /> S <br /> ttjj <br /> \ <br /> �� CONFLICT OF INTEREST <br /> V(N,_ 1 <br /> City of Sunny Isles Beach <br /> - • 18070 Collins Avenue <br /> ;'• �o.:oSunny Isles Beach,FL 33160 <br /> o. sus l'eTelephone:(305)947-0606 Far.(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 /> COUNTY OF BIze tti A-R i1 <br /> BEFORE ME, the undersigned authority, personally appeared JOSEPU 14-- Pmt t Lo X/ who was duly sworn, <br /> deposes, and states: / <br /> 18.1. I am the RA-tit AiGe(i of <br /> INTES.NAT(ar4At- Limo or S. FLwith a local office in WEST PA42-K c1oP/A4 and principal office in <br /> S AME La CATION <br /> 18.2. The above named entity is submitting.a Bid for the City of Sunny Isles Beach, Bid No. 16"03.O I 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 /> 18.81 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 th' z0 day of MARCH , 2016 Jiff <br /> .TOSEPN H. PwLo?c/ <br /> Print or Type Name and Title <br /> �'” day HeirClti <br /> Sworn to and subscribed before me this z' of , 201 ? � <br /> 0 Personally Known OR <br /> 9' Produced Identification ✓ ; Type o .-� ll' It o, t a VC a �' CenQ <br /> RIDA <br /> 0.'rh, CH IDA REMOGENE / <br /> tir Commissions FF 182856 <br /> •%ffti•, My Commission Expires <br /> ,. ; Dslombar 14. 261E <br /> -.4 mh......6~. +res <br /> DECEMBER 28,2010 5 of 7 <br />