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<br />SECTION 19 <br />CONFUCT OF INTEREST STATEMENT <br /> <br />STATE OF FLORIDA <br />COUNTY OF <br /> <br />BEFORE ME, the undersigned authority, personally appeared ~'f\J OhJrC) <br />was duly sworn, deposes, and states: <br />., <br /> <br />19.~. I am tbe .:vt~'Qm-\- . ~., d ' <br />( J, \ - \\ d Q ~ ~ r~Gn\ with a local office in 1.:?...5 N r0 163' t. B ~h (~ m \ <br />principal office in \ '\,\ \ f'H" \i. \:t . <br /> <br />19.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. <br />(')~ -Oh-<'},).. described as: Janitorial Maintenance Services. <br /> <br />. who <br /> <br />of <br />and <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 notify the City of Sunny Isles Beach. <br /> <br />Dated this <br /> <br />day of <br /> <br />.2007. <br /> <br />,~\,~r( r <:W-~ <br />AFFIANT Print or Type Name and Title <br /> <br />SW9mto ancLsubscrib.ed--J?efore me this 12-fday of ~ <br />GY Personally Known ) OR <br />Cl Produ entification ; Type of Identification <br /> <br />. 200~~' <br /> <br />~lIruIfA'IlII1NllfIIIIIIIIIJIlIlIlIIlIlIlIlIfIlIllU""IIIIlIlIlIlIlIlIlIlIlIlfIlC <br />E DREW OGHINAN ~ <br />~ Notary Public State of Florida i NOTARY PUBUC STATE OF FLORIDA <br />~ My Comm. Exp 11/28/2011 i <br />i Commission # 00737329 E <br />. '''lIrlll""IIIIfIIIIOIllllllnUttltunJIIIUlllllliUlUflllllllllllll''''~ <br /> <br />PAGE 75 OF 78 <br />