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tVµN--rrr <br /> _�i <br /> CONFLICT OF INTEREST <br /> • <br /> • <br /> City of Sunny ISIes Beach <br /> 18070 Coar4 Avenue <br /> % 1'. o•s.�- Sunny Isles Beach.Ft. 33160 <br /> Telephone:(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 grLward f <br /> BEFORE ME, the undersigned authority, personally appeared PI2L.L ( -a;-y1 p i who was duly sworn, <br /> deposes,and states: II1 <br /> 18.1. I am the «v' e Pres eae `l of <br /> Tile (P e,>i Snd.cce Trlejth a local office in /4r I t s t F7_ 3..3c49 and principal office in <br /> /J <br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. i&-09-l2 3 described <br /> • as: L .r The Affiant has made diligent inquiry and provides the information contained in this <br /> Affidavit based upon his own knowledge. E v e -t' iclas 69,,h ( • <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 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 /> c4 kl.Dated his)n) day of ('�[^+r)Coe(' .2aj , <br /> y Pay, 1 <la:,, itse ere5ic e 't <br /> AFFIANT Print or Type Nariie andNa Title <br /> t c7/6 <br /> Sworn to and subscribed before me this lV day of (,42h'r .Za4er <br /> O / Personally Known OR T--7- <br /> -/ n/ <br /> IU/ Produced Identification �;Type of Identifica'•n r L� �/C� <br /> NOTARY PUBLIC STATE OF FLORIDA • <br /> `;'tct, JEKTOR AYALA <br /> �.!¢1> , MY COYNISSION 1 FF 911313 <br /> , •'ni' 4 EXPIRES:October 3,2019 <br /> '.,� nc 1�.-�a:r.�r a�dgrl N my 54nia <br /> OECEuEEn M2010 5 of 7 <br /> "e� o-J <br />