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<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 FLO.,ijIDA \
<br />COUNTY OF .~~o v.:> 0...... a,
<br />
<br />BEFORE ME, the undersigned authority, personally appeared ~ 0....,."""" lY\ ~ ~ ct..4 ~.... ,who was duly sworn,
<br />deposes, and states:
<br />
<br />18.1. I am the 71"~~ ,~~"*
<br />c.oe,..,.,.~"'-' Co.... ~ 't> Q...., c.. \ with a local office in ~c \\"i v.:>oo'b
<br />\4. 0\\"'" ~CO~
<br />.
<br />
<br />of
<br />and principal office in
<br />
<br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. .,.. 0 ? b' described
<br />as: ~eABGGaJ3e Mtlil ,le"Cl"c~ OG, v;"",~. The Affiant has made diligent inquiry and provides the information contained in this
<br />Affidavit based upon his own knowledge."'" ";l \' .. , . 'CL _"":"0. '"!'"
<br />D'-,\ct. "'\~\.c.. ~"'i "o.."'~ .---.q rc:r.t ~","e-~.s
<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 />18.71 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! 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 :!;Ies Beach.
<br />
<br />
<br />t is identified in the provision of services, I, on behalf of the above named entity, will
<br />Beach.
<br />
<br />v.."" lL....
<br />
<br />,201..
<br />
<br />
<br />S~rn to and subs . ed before me this ~ day of :s ~-...q. ,2010.
<br />~ Personally Known OR
<br />o Pcod"ced Ide"tifi",tio" ; Type Of~~
<br />
<br />
<br />NOTARY PUBLIC STATE OF FLORIDA
<br />
<br />""::ii.y'r~"',, JENNIFER CAMERON
<br />f:~"!-iJ':~ MY COMMISSION # DO 841514
<br />",,:.. ,:.; EXPIRES: March 25, 2013
<br />-'1.*, Fl'; '" , .. Bonded Thru Notary Public Underwriters
<br />'I IIU"\
<br />
<br />DECEMBER 28. 2010
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