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<br /> <br />CONFLICT OF INTEREST <br /> <br />city of Sunny Isles Beach <br />18070 Collins Avenue <br />SUrmy Isles Beach, FL 33160 <br />Telephone: (305) 947-Q6lJ6 Fax: (305) 949-3113 <br /> <br />CONFUCT OF INTEREST STATEMENT <br /> <br />The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must <br />disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the <br />City of Sunny Isles Beach or its agencies. <br /> <br />STATE OF FLOF,JIDA a../. r <br />COUNTY OF ~l)fl ~l.t <br /> <br />BEFORE ME, the undersigned authority, personally appeared .....(1lIDr(\,\ 1i:J,tQc& \ ( <br />deposes, and states: ' <br /> <br />18.1. I ,am the -{) W vte.. r- of <br />.s ha.~ 7t "'-'< e... LL C with a local office in 1; 0 LOI ~ I f=L and principal office in <br />.-gq-C\ p.a-J.c r'\ L FL- <br /> <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. II - () L -0 I described <br />as: Lands~ Ma!!Jterfa'nce Services. The Affiant has made diligent inquiry and provides the information contained in this <br />Affidavit,ra-sed upon his own knowledge. <br /> <br />, who was duly sworn, <br /> <br />18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has <br />no financial interest in other entities submitting Bids for the same project. <br /> <br />18.4 Neither the Affiant nor the above named entity has directly or Indirectly entered into any agreement, participated in <br />any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for <br />the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and <br />execution of the Contract for this project. <br /> <br />18.5 Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from <br />participation in contract letting by any local, State, or Federal Agency. <br /> <br />\ <br /> <br />18.6 Neither the entity, nor its affiliates, nor anyone associated with them have al1Y potential conflict of interest due to any <br />other clients, contracts, or property interests for this project. ' <br /> <br />18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or <br />actively seeking an elected position with the City of Sunny Isles Beach. <br /> <br />18.8 I certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City <br />of Sunny Isles Beach. <br /> <br />\ <br /> <br />18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will <br />immediately notify the City of Sunny Isles Beach. <br /> <br />pjl., dayof NJ.I\ . . 201.. ' f" /" <br />, 1 \L-et/~,.. Jt/Ldtf0Iat:i~"-L yt.1.&;t1a5'('-t r f?il l-(er <br />ANT Print or Type Name and Trtle <br /> <br />S ~to and subscribed before me this JS- day of <br />~om I Personally Known OR <br />a Produced Identification ; Type of Identifi <br /> <br />.' ~"H;"'o. JASON R. WESTFORT <br />;~'i)\~ MY COMMISSION ltDD992109 <br />~'. :"J EXPIRES: June 13.2014 <br />~~~, Bonded TIuu Notary Public Underwriters <br /> <br /> <br />\.. <br /> <br />NOTARY PUBLIC STATE OF FLORIDA <br /> <br />" <br /> <br />DECEMBER 28. 2010 <br /> <br />50f7 <br /> <br />l <br />'- <br /> <br />( <br />L <br /> <br />20 <br />