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<br />.11-'5 cD\n~ J LL C- dl b\o.. <br />~F-P f.lc).: 11- D4-Dt <br />30 <br /> <br />~ I A-Ss \~G Q t+ -l:eJtC ~5 <br /> <br />(~, <br />\S, .~')'/, <br />---.:_~--~:;~:, <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 />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 FLOR.f)~ <br />COUNTY OF f/ <br /> <br />BEFORE ME, the undersigned authority, personally appeared <br />deposes, and states: <br /> <br />JJ/MJO <br /> <br />5f2.JiCce ~i~l <br />~ \ tOU'i ;-PLc ifd..o-- <br /> <br />~( (A.. <br /> <br />, who was duly sworn, <br /> <br />18.1. I am tIl( J.h~_ erS <br />~~CtxoU~c.. ~o L Ml5;C l!J't'C-' with <br />_ 1\{lM.L__l,,~ <br /> <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. Il ~ 04 - 0 ( 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 />a local office in <br /> <br />of <br />and principal office In <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 />;r~-0f~~-{ <br /> <br />AFFI NT <br /> <br />S~tn to and subscribed before me this ~ day of <br />[) Personally Known OR <br />o Produced Identification ; Type of Identification <br /> <br />/. .~ <br /> <br />II <br /> <br />e,#/1_-'6t:A AJ tiA'J/J. ~R.' 2~e I).., sidt#I"1 <br />Print or Type Name and' Title <br /> <br />~(jl <br /> <br />,20ft <br /> <br />~~~ <br />'<tI":" CONSUeLOM.GAFICIA <br />\ i*f MY COMMISSION' DO 8777flt <br />~.N' .'~ EXPIRES: April 6, 2013 <br />'4,Ri!.~. Booded Thru NoIaIy Public Undenwtlers <br /> <br /> <br />) <br /> <br />NOTARY PUBLIC STATE OF FLORIDA <br /> <br />DECEMBER 28. 2010 <br /> <br />5 of 7 <br />