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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 />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~A
<br />COUNTY OF ----J,)t:AA" 0
<br />
<br />BEFORE ME, the undersigned authority, personally appearedJ; ,~ ~ 11~ who was duly sworn,
<br />
<br />
<br />;;'.",aod'tat.. am ~. ~'" P/...€.~J.urT of
<br />It./!)/I Qllll~71j.l ~&>- J'W 'o~:f,;.. '0 GnuET Lfj '" n'l1 ';Z :;;p;~ ':
<br />
<br />18,2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. J 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 />18.71 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 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 ~Of Sunny Isles Beach.
<br />
<br />~t~ ' day of Ju."je ~ ~l n . Ji.
<br />.:::J1J1iL?€ IJ (') p a.... I./~ ~ l{.Jl AfT
<br />~ T Print or Type Name and Title
<br />
<br />~~rn to and subscribed before me this I $;f day of
<br />V Personally Known OR
<br />o Produced Identification ; TYP~
<br />
<br />NOTARY PUBLIC STATE OF FLORIDA
<br />
<br />
<br />DECEMBER 2B, 2010
<br />
<br />5 of 10
<br />
<br />lWTARY UC-8TATE OF FLO!UDA
<br />~"..."II"""..~ Laura A. Gonzalez
<br />5 ~ ~ Commission # DD842247
<br />"#"""...../ Expires: DEC. 05, 2012
<br />BONDED TRRO' A1'.LANTIC BONDING CO.,INe.
<br />
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