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<br />CONFLICT OF INTEREST
<br />
<br />City of Sunny Isles Beach
<br />, 16070 Collins Avenue
<br />Sunny Isles Beach, FL 33160
<br />Telephone: (305) 947-0606 Fax: (305) 949-3113
<br />
<br />CONFLICT 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 NEW YORK
<br />COUNTY OF MANHATTAN
<br />
<br />BEFORE ME, the undersigned authority, personally appeared 4n I)} y Lu.J i..IJ.A./ I ~ p, who was duly sworn,
<br />deposes, and states:
<br />
<br />181. ' I am, the (ff.fr;; (~d of
<br />~5~-:.v(~~n.v.~/r_l_,lI~iJwith a local office in " Vr9--R'IL and principal office in
<br />
<br />
<br />1 E2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No, 11- 0 2 - 0 Z described
<br />as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained In this
<br />Affidavit based upon his own knowledge,
<br />
<br />1m 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 />1m 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 />1 m 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 Ipcal, State, or Federal Agency,
<br />
<br />11B Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of interest due to any
<br />other clients, contracts, or property interests for this project
<br />
<br />18' I 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 />1lB I certify that no member of the entity's ownership or management, or staff has a vested I nterest in any aspect of the City
<br />of Sunny Isles Beach,
<br />
<br />181 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 />Dated th~ ( day of f)1 t2t.l/e-A ,201~
<br />'1iA' &'L-- 4---rJ(<<Iv b......) (...o..A.J~ ",..I , f/I",LS,
<br />AFFIANT ' Print or Type Name and Title I
<br />
<br />,Sworn to and subscribed before me this L day of ft11J.I .// / ~ , 201~,
<br />~ Personally Known OR
<br />o Produced Identification ; Type of Irltion ,
<br />
<br />
<br />NOTARY PUBLIC STATE OF NEW YORK Al.JL(><- f{ r
<br />CAROLYN NEPO
<br />NOTARY PUBLIC-STATE OF NEW YO~K
<br />No. 01NE6117340
<br />QuclUled In Nassau countv;
<br />My CommlUlon Expires I () I? j- / ~
<br />r I
<br />
<br />DecEMBER 28, 2010
<br />
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