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<br />CONFLICT OF INTEREST
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<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
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<br />CONFLICT OF INTEREST STATEMENT
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<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,
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<br />STATE OF FLORIDA
<br />COUNTY OF Miami - Dade
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<br />BEFORE ME, the undersigned authority, personally appeared
<br />deposes, and states:
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<br />Carlos Mallol, P,E" D,B,A
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<br />, who was duly sworn,
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<br />18.1. I am
<br />CSA Central, Inc,
<br />Miami
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<br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No, 11-11-02 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,
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<br />the
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<br />Senior Vice President
<br />with a local office in Miami
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<br />of
<br />and principal office in
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<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.
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<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.
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<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,
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<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.
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<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,
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<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,
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<br />18.9 In the event t~at a iPyflict of in est is identified in the provision of services, I, on behalf of the above named entity, will
<br />immediately notify th ty of Sun sles Beach,
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<br />Dated' tf. day of November ,2010.
<br />Carlos Mallol, P.E" D,B,A. - Senior Vice President
<br />AF I . / / Print or Type Name and Title
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<br />Sworn tolar(: subscribed before me this 28 day of November , 2010,
<br />~ Personally Known x -OR
<br />o Produced Identification ; Type of Identification
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<br />DINA K, RHYMES
<br />/'0~ Notary Public - State of Florida
<br />~ .; My Comm, Expires Aug 16, 2014
<br />~"'..' . Q"<g Commission # DD 986056
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<br />"~,7r,r,,;,'" Bonded Through NatIOnal NOla! \ ",5fl
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<br />DECEMBER 28. 2010
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