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<br />~ <br /> <br /> <br />CONFLICT OF INTEREST <br /> <br />City of Sunny Isles Beach <br />18070 C<lllins Avenue <br />Sunny Isles Beach. FL 33160 <br />Telephone: (305) 947.{J6(J6 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 FLORIDA ~ ,..., ~ <br />COUNTY OF ~. M ~c...r- ' <br /> <br />BEFORE ME, the undersigned authority, personally appeared <br />deposes, and states: <br /> <br />18.1. I am the -rv'\A-rJA6'NG. ~ of <br />pc.!f~"':f ~ <:.- """ a ''''''' offire '" !::h-~ aod P"""'~ offire '" <br /> <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 />1\.)11 <br /> <br />~D/JoJ <br /> <br />, who was duly sworn, <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 City of Sunny Isles Beach. <br /> <br />~atedthii ~ day of j ul'J 201'. <br />\J ~Abtf'-J N\CJ ~ <br />AFFIANT '1 Print or Type Nam~ <br /> <br />~~m to and subscribed before me this _ day of <br />1!I... Personally Known . OR <br />o Produced Identification ; Type of Identification <br /> <br /> <br />,2010. <br /> <br />NOTARY PUBLIC STATE OF FLORIDA <br /> <br />".II~I""'i <br />:$'t.'.fIi~ KflYSTALCOURCHENE <br />[.{ ':~ MY C'~ISSION # EE llOO266 <br />EXP!RES: OClOOOr 12,2014 <br />Bonded Thru Notary PoIJJIc Undenmlers <br /> <br />~R2B,2010 <br /> <br />5 of 10 <br />