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<br />) <br />) <br />) <br /> <br />) <br />) <br />) <br /> <br />) <br /> <br />) <br /> <br />) <br />) <br /> <br />) <br /> <br />) <br /> <br />) <br /> <br />) <br /> <br />) <br /> <br />) <br /> <br />, <br />, <br /> <br />) <br /> <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 FLORIDA <br />COUNTY OF VV1 i am" - iX1 d. (I /' <br /> <br />BEFORE ME, the undersigned authority, personally appeared~tl\e.S <br />deposes, and states: <br /> <br />1~.J' '~ D the 5(/' ~~LCazJ..svlfi~ of <br />~. Yorl<- ~ 1-eSov~ localoffi e ;;;--- ry an Indpal office Ie <br /> <br /> <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. I ~ - 0 I - 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. <br /> <br />A I -F;:~~ 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 />~~ .... ;).0 1 d-. <br /> <br />~"-l daY~.R(j~:,es 4, Fr,*",,~~':'.SVP ~~L a....vt-b' <br />A p. ~ ~ ~ nnt or Type Name and Title) 7 l' <br />I r <t.. -- c9-0 I d..-- <br />Sworn to and subscribed before me this ~ day of fEi3;!? tlA/ef ' 2f}1:(1: <br />~ Personally Known OR <br />o Produced Identification ; Type of Identification <br /> <br />J{(~iU. rff&cf <br /> <br /> <br />KIRA M. ELBOURY <br />NOTARV PUBl.IC-STATE OF NEW YORK <br />No.01EL6127202 <br />Qualified in Westchestor County <br />My Commission Expires May 23, 2013 <br /> <br />NOTARY PUBLIC STATE OF EJ.OR.IDA- <br />)/[/;1/ Y d1!K <br /> <br />DECEMBER 28, 2010 <br /> <br />5 of 7 <br />