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<br />
<br />CONFLICT OF INTEREST
<br />
<br />City of Sunny Isles Beach
<br />18070 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 />STATE OF FLORIDA"fL-
<br />COUNTY OF
<br />
<br />
<br />The award of any contract hereunder is subject to the provisions of Chapt 12, orida State Statutes, Proposers must
<br />disclose with their Bids, the name of any officer, director, partner, associa or age who is also an officer or employee of the
<br />City of Sunny Isles Beach or its agencies,
<br />
<br />BEFORE ME, the undersigned authority, personally appeared
<br />deposes, and states:
<br />
<br />18.1. I
<br />(~'~
<br />
<br />a~ the
<br />( rs. Cc~r.
<br />
<br />v~ C-L
<br />with a local
<br />
<br />of
<br />nd principal office in
<br />
<br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 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 />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 />18.6 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 />18.7 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 />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 />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 />
<br />9~t~~J~J~CcvJ'\;flhof Hc~ Vl(fJ \XW.h~l-t ,201~,
<br />AFFIANT Print or Type Name and Title
<br />
<br />Sworn to and subscribed before me this ~ day of t--{ ((.<1 ' 201 r/;,
<br />o Personally Known OR q 0
<br />~ Produced Identification ./ ; Type of Identification D I Fie z 3Y 's2 052 l 0
<br />
<br />cJauct a bq, hce 12.0 l tJ vicvlj ~(Jb IrC ')
<br />
<br />NOTARY PUBLIC STATE OF FLORIDA
<br />
<br />DECEMBER 28, 2010
<br />
<br />5 of 10
<br />
<br />~ -
<br />",........ CLAUDIA 8ALAREZO
<br />...' ~..y Dv. 'r,
<br />lm'~ 6<t:\ Notary Public. Slale 01 Florida
<br />to . . ~ My Comm EJlplles Noy 2, 2014
<br />~~~ .'.: CommIsSion" H 39632
<br />""q"W.:.\~", Boncled Tllrouglt ttallonal Notary AsIn. ·
<br />
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