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<br />SECTION 19 <br />CONFLICT OF INTEREST STATEMENT <br /> <br />STATE OF FLOB1CA. 0 <br />COUNlYOF ~ <br /> <br />19. <br /> <br /> <br />who <br /> <br />BEFORE ME, the undersigned authority, persona II <br />was duly sworn, deposes, and states: <br /> <br />of <br />and <br /> <br />19.2~, (Y J'J1 The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. <br />v 6 '7/0 -t) ')/' 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 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 noti he City of Sunny Isles Beach. <br /> <br />Dated this ryz; day of <br /> <br /> <br />20~ <br /> <br />AFFIANT Print or Type Name and Title <br /> <br />SWorn ~ subscribed before me this U day of ~ . 20rR? <br />~ Personally Known ~Pu. TincOR<Wiatkowski~ ~ <br />o Produced Identification : ,_ . My1:q~ofila cat"o. ,,~ <br />0' ,..o~ Expires January 24, 2 <br /> <br />NOTARY PUBUC STATE OF FLORIDA <br /> <br />PAGE 75 OF 78 <br />