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<br />
<br />CONFLICT OF INTEREST
<br />
<br />Of SIJ1'4
<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 FLORIDAd I ()
<br />COUNTY OF D ~ ~
<br />
<br />~fAel Sl~Uf\
<br />
<br />, who was duly sworn,
<br />
<br />BEFORE ME, the undersigned authority, personally appeared
<br />deposes, and states:
<br />
<br />18.1. I am the UADC\toE: R...
<br />~(X"-\.(I\) eo,..y::,"'jl(D<:nD\...J c.1:l. with a local office in .l-J,Q/ V,W, I:3CI 5T .tJ.4r#-4-
<br />SA.uf'_ oPAL-oct.4l) F( .5 3051
<br />
<br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No, \ \ -OS ~O I described
<br />as: ~,I,d5""df..le MCllllt~lld"ec 8c~ The Affiant has made diligent inquiry and provides the information contained in this
<br />AffidaVit based upon his own knowledge,............1e\\Ll V'\S-t A~:;:?<<" .
<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 />of
<br />and principal office in
<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 />18.81 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 />~a.t d /lis J day of Jvl4Y ,2014,
<br />~ 'j'2A~.AeL. SIl-..v'A / t.-{At-.JA~cR.
<br />AFFIA :r Print or Type Name and Title
<br />
<br />Sworn to and subscribed before me this -.1L day of MAY
<br />u:;v'"' Personally Known OR
<br />o Produced Identification ; Type of Iden~flOiitioo.....""""""""""""""":
<br />.
<br />D 717709 5
<br />.
<br />res 9/23/2011 .
<br />5 \~ ,i1i :
<br />: ~~OF",~$' Florida NotaIy Assn., \nC :
<br />~. "'1 :'.~.. '1' .......... II' .... .... ......... I'
<br />
<br />,2010.
<br />
<br />NOTARY PUBLIC STATE OF FLORIDA
<br />
<br />
<br />DECEMBER 28. 2010
<br />
<br />5 of 10
<br />
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<br />
<br />t-JAH \\)..) (1~;t e.J c) l C ....J
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