Laserfiche WebLink
<br />I <br /> <br />l <br />. <br /> <br />SECTION 19 <br />CONFLICT OF INTEREST STATEMENT <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />i <br />I <br />I <br />I <br />I <br /> <br />STATE OF FLORIDA <br />COUNTY OF <br /> <br />BEFORE ME, the undersigned authority, personally appeared <br />was duly sworn, deposes, and states: <br /> <br />, who <br /> <br />19.1. <br /> <br />I <br /> <br />am <br /> <br />the <br /> <br />with a local office in <br /> <br />of <br />and <br /> <br />principal office in <br /> <br />19.2. <br /> <br />The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. <br />described as: Janitorial Maintenance Services. <br /> <br />19.3. The Affiant has made diligent inquiry and provides the information contained in this Affidavit <br />based upon his own knowledge. <br /> <br />19.4. The Affiant states that only one submittal for the above bid is being submitted and that the <br />above named entity has no financial interest in other entities submitting bids for the same project. <br /> <br />19.5. Neither the Affiant nor the above named entity has directly or indirectly entered into any <br />agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive <br />pricing in connection with the entity's submittal for the above bid. This statement restricts the discussion <br />of pricing data until the completion of negotiations if necessary and execution of the Contract for this <br />project. <br /> <br />19.6. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or <br />otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. <br /> <br />19.7. Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict <br />of interest due to any other clients, contracts, or property interests for this project. <br /> <br />19.8. I certify that no member of the entity's ownership or management is presently applying for any <br />employee position or actively seeking an elected position with the City of Sunny Isles Beach. <br /> <br />19.9. I certify that no member of the entity's ownership or management, or staff has a vested interest <br />in any aspect of the City of Sunny Isles Beach. <br /> <br />19.10. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the <br />above named entity, will immediately notify the City of Sunny Isles Beach. <br /> <br />Dated this <br /> <br />day of <br /> <br />,2007. <br /> <br />AFFIANT <br /> <br />Print or Type Name and Title <br /> <br />Sworn to and subscribed before me this _ day of <br />o Personally Known OR <br />o Produced Identification ; Type of Identification <br /> <br />,2007. <br /> <br />NOTARY PUBLIC STATE OF FLORIDA <br /> <br />PAGE 75 OF 78 <br />