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SV e G/ _, ...„....-4CONFLICT OF INTEREST City of Sunny Isles Beach 18070 Collins Avenue `. •J 7 S�mb ny IsBeach,FL 33160 o, •u,.'o Telephone:(305)947-0606 Fax(305)949-3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids,the name of any officer,director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF Broxard BEFORE ME, the undersigned authority, personally appeared Jason R. Wells who was duly sworn, deposes, and states: 18.1. I am the President of Jacey Investments,L.I.C.d/b/a Elite Tent Companyyith a local Office In West Park,FL and principal office in west Park FL 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 16-08-01 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients,contracts, or property interests for this project 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 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 of Sunny Isles Beach. 18.9 In event that a e• "• • rst is identified in the provision of services, I, on behalf of the above named entity, will immedia nob - Ci of :*••. Isles ::.ch. at i ' fi:y it p ,. I • ,2444 FIAN ill,t Jason R.wens.Prescient Print or Type Name and Title m to and subscribed before me this 28rd day of August 2016 Personally Known OR Produced Identification ;Type of Identification NOTARY PUB . $ r•": ;. LETICIA ROMAN MY COMMISSION C FF244a07 EXPIRES June 25,2019 4 NCn 39633Floripareu,rs.n¢..:an DECEMBER 28,2010 5 of 7