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4 CONFLICT OF INTEREST <br />City of Sunny Isles Beach <br />(�' 18870 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephom: (306) 947 -0606 Fax (305) 943.3113 <br />CONFLICT OF INTEREST STATEMENT <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 />STATE OF FLO IDA <br />COUNTY OF ( <br />BEFORE ME, the undersigned authority, personally appeared �' M �.{ \A �( m I�/ <br />� , who was duly swom, <br />deposes, and states: <br />18.1. I am the W V'e r of <br />-5 hGt. _ 'Tt VIA L with a local office in c �C _ and principal office in <br />ejaAgri 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. )1-- .0 Z `'described <br />as: Lands Mairteir6ance Services. The Affiant has made diligent inquiry and provides the information contained in this <br />Affidavitlased upon his own knowledge. <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 />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 />18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from <br />participation in contract letting by any local, State, or Federal Agency. <br />18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any <br />other clients, contracts, or property interests for this project <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 />18.81 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 />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 />this day of 201 � rta � � k ^ fct e� <br />WL �' <br />NT Print or Type Name and Title <br />to and subscribed before me this -& day of <br />����jjjj Personally Known OR <br />O Produced Identification ;Type c <br />NOTARY PUBLIC STATE OF FLORIDA <br />JASON R. wESTFORT <br />MY COMMISSION #DD 992109 <br />EXPIRES: June 13, 2014 <br />Bonded Tbm NAq public Underwriters <br />DECEMBER 28, 2010 <br />5 of 7 <br />O <br />