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1V�—_�rrl <br /> • + .\:� CONFLICT OF INTEREST <br /> \` / City of Sunny Isles Beach <br /> 18070 Cnertc Avenue <br /> _- o <br /> o Sunny Isles Beach,FL 33160 <br /> o, w Telephone:(305)947-0606 Fa.:(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. Propncars 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 4' cncOCA <br /> BEFORE ME, the undersigned authority, personally appeared 1<0.(Fr.1 1C)C732,2 , who was duly sworn, <br /> deposes,and states: <br /> 18.1. I am the ?(eD Cien3 I C0 of <br /> /ACT`O(\uwa t1-nlAccmec*' with a local office in Folk \-0a,1Jktnk$t and principal office in <br /> l c9$k- \n1 VATeti <br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. IL-0-1-CS desoribed <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 /> 18.7 1 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 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 /> 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 /> COP-,-1,11 ��oo1L� <br /> Dated this p23 _—dapelP@1p. <br /> �`re41 -k4cbOP�2 KAREI-' \\ccvEe, ?p.€SbD St + Ct O <br /> AFFIANT /.- /� _.� Print or Type Name and Title <br /> Sworn to an subscribed beforefome this 073 day of M1.\_ ,2&it.).Ol b <br /> 3/ Personally Known OR Q <br /> O Produced Identification ;Type of Identification <br /> NOTARY PUBLIC STATE OF FLORIDA <br /> ROCCO O PACIELLO <br /> !..'.. NOTARY PUBLIC <br /> 4;4 : STATE OF FLORIDA <br /> ii:.'s: <br /> Connti FF041337 <br /> - Expires 7/31/2017 <br /> CELE latia23.2010 5of 10 <br /> 4 <br />