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<br />- <br /> <br />SECTION 19 <br />CONFUCT OF INTEREST STATEMENT <br /> <br />STATE OF FLORIDA A <br />COUNTY OF ~ It P <br />- <br /> <br />BEFORE ME, the undersigned authority, personally appeared \Y\l1.(i-t\?li f(: jJ rJ . who <br />was duly sworn, deposes, and states: <br /> <br />19~. I am <br />~(JJ ~(Z- <br />prlndpal fflce In <br /> <br />the <br /> <br />o (A )~e..-" of <br />with a local office n ~ ~ ~ POYlA &20'1.0 t 2. r~ 1J..-2.,J# tgfRj <br />. DI~fJUt\.O ~.2...e. i-L 33661 <br /> <br />19.2. The above named entity is submitting a Bid for the Oty of Sunny Isles Beach, Bid No. <br />()"8 ..- 0 6 - O(). 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 f1nandallnterest 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, partidpated in any collusion, or otherwise taken any action In restraints of free competitive <br />pridng 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 dients, 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 /> <br />mr vl~. dayol <br />\, W II\. 'l- <br />AA Print or Type Name and <br /> <br />Sworn to and subscribed before me this 4k day ofGv/.;1 t <br />~ Personally Known OR <br />Cl Produced Identification ; Type of Identification <br /> <br />. ~- <br />NOTARYPUBllC~ <br /> <br /> <br />I.JJnif) <br /> <br />. 2001:' <br /> <br />PAGE 75 OF 78 <br /> <br />