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<br />o <br /> <br />o <br /> <br />o <br /> <br />. <br /> <br />SECTION 19 <br />CONFLICT OF INTEREST STATEMENT <br /> <br />STATE OF FLORIDA <br />COUNTY OF 6r<.. 6 w A-~O <br /> <br />f)I+NI fL f), wtlKLi:i , who <br /> <br />\I INt!.. <br />of Wt.E.k Lf. f Asfl14Lr 1'/JIIIN6.; with <br />and principal office in PLrnt3R.D!<L I'/lv,[,5 ,cL. . <br />. <br /> <br />BEFORE ME, the undersigned authority, personally appeared <br />was duly sworn, deposes, and states: <br />19.1. I am the PiX.E5;oirJl" <br />a local office in PErn(3l{bl<{ t'/I"':'S ,cL <br /> <br />19.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 08-10-01 <br />described as: SR A1NCollins Avenue Streetscape Improvements. <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 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, 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 has any potential conflict of <br />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 />AFFIANT <br /> <br /> <br />Dated this g T H day of D Le t: II] 6 c. <br />WEEKLEY ASPHALT PAVING, INC <br /> <br />20...QK. <br /> <br />DAN1 <br />Print or Type Name an <br /> <br />Sworn to and subscribed before me this C/, ff day of {) [c. L hi f) [~ <br />o Personally Known X OR <br />o Produced Identification ; Type of I <br /> <br />~. <br /> <br />NOTARY PUBUC-STATE OF FLORIDA <br />........."", Teresa Patane <br />t~ j Co~mis.sion # DD680356 <br />""....... ExpIres. JULY 16, 2011 <br />BONDED THRU ATLANTIC BONDIN''';O., 1Nl:. <br /> <br />N <br /> <br />PAGE 80 OF 130 <br />BID No. 08-10-01 <br />