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<br />..... <br /> <br />SECTION 19 <br />CONFLICT OF INTEREST STATEMENT <br /> <br />STATE OF FLORIDA <br />COUNTY OF <br /> <br />BEFORE ME, the undersigned authority, personally appeared <br />sworn, deposes, and states: <br /> <br />, who was duly <br /> <br />19.1. I am the <br />with a local office in <br /> <br />of <br /> <br />and principal office in <br /> <br />19.2. The above named entity is submitting a Proposal for the City of Sunny Isles Beach, RFP No. <br />described as: Emergency Debris Clearing and Removal Operations. <br /> <br />19.3. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his <br />own knowledge. <br /> <br />19.4. The Affiant states that only one submittal for the above Proposal is being submitted and that the above <br />named entity has no financial interest in other entities submitting proposals for the same project. <br /> <br />19.5. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, <br />participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with <br />the entity's submittal for the above proposal. This statement restricts the discussion of pricing data until the <br />completion of negotiations if necessary and execution of the Contract for this project. <br /> <br />19.6. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise <br />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 of interest <br />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 employee <br />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 in any <br />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 above <br />named entity, will immediately notify the City of Sunny Isles Beach. <br /> <br />Dated this <br /> <br />day of <br /> <br />,2008. <br /> <br />AFFIANT <br />Sworn to and subscribed before me this _ day of <br />o Personally Known OR <br />o Produced Identification ; Type of Identification <br /> <br />Print or Type Name and Title <br />,2008. <br /> <br />NOTARY PUBLIC STATE OF FLORIDA <br /> <br />76 <br />