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<br />~ <br /> <br />SECTION 19 <br />CONFLICT OF INTEREST STATEMENT <br /> <br />STATE OF FLQfU@A l <br />COUNTY OF ~lv.t 8 t.4L <br /> <br />BEFORE ME, the undersigned authority, personally appeared ~) k\l\. f l (1 2D () ~ <br />was duly sworn, deposes, and states: I <br /> <br />PI1 ~ " Jtt-C--\ <br />with a local office in \Ah~.{..tt:toM I~~L <br /> <br />, who <br /> <br /> <br />of <br />and <br /> <br />19.2. <br />bv -(), -t>.l. <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 entitles 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 associatec:l 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 />Da~I~. day of . 2007. <br />~~~----~--- DOlJG--l.~~ S. C:J IO/2..t)~ <br />AFAANT Print or Type ~e and Title r" <br />2-()(J &' <br />Sworn to and subscribed before me this --LL day of .~ <br />~ Personally Known OR <br />CJ Produced Identification ; Type o~ entification <br /> <br />NOTARY PUBUC <br /> <br /> <br />.. <br />i~~3\. Notary f)utllic SUl'e of Florida <br />. . EI.lne Moae"eltl <br />'1 c. ,4 My Commi..ion 00747355 <br />~Of...." Exolrel103l01/2012 <br /> <br /> <br />PAGE 75 OF 78 <br />