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<br />
<br />CONFLICT OF INTEREST
<br />
<br />City of Sunny Isles Beach
<br />18070 ColIJni Avenua
<br />Sunny IslsliI Beach, FL 33160
<br />Telephone: (305) 1147.0608 FaX' (305) 949.3113
<br />
<br />CONFLICT OF INTEREST STATEMENT
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<br />The award of any contract hereunder Is subjeclto the provisions 01 Chapter 112, Florida State Stalutes. 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 tha
<br />City of Sunny Islas Beach or its agencies.
<br />
<br />STATE OF FLORIDA t;
<br />COUNTY OF 1 V J
<br />
<br />BEFORE ME, the undersigned authority, personally appeared . ~ 0vcJ.t!
<br />deposes, and states: (l, . ti (, ,;',
<br />
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<br />
<br />
<br />18.2. The above Zd entity Is submitting a Bid for the City of Sunny Isles Beach, Bid No. /2 .61.4---,--, 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 />, who was duly sworn,
<br />
<br />18.3 The Affiant states thai only one submlUel for the above Bid Is baing submitted and that the above named entily has
<br />no financlai Interest in other entities submitting Bids for the same project.
<br />
<br />18.4 Neither the Affiant nor the above named entity has dlractty or indirectly entered Into any agreement, particlpeted in
<br />any collusion, or otherwIse taken any action In restraints of free competitive prIcing In connection wfth 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 01 the Contracl for this project.
<br />
<br />18.6 Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from
<br />participation in contreclletting by eny locel, State, or Federal Agency.
<br />
<br />18.6 Neilher the entity. nor its affiliates, nor eny one essociated with them have any potential conflict of Interest due to any
<br />other clients, contrects, or property Interests for this project.
<br />
<br />18.71 certify that no member of the entlly'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 />18.81 certify that no member of the entity's ownership or management, or slaff has a vested Interest In any aspect of the City
<br />of Sunny Isles Beach.
<br />
<br />18.9ln 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 />.-; +1\ (- n L
<br />Dated this I - dey of 1'",,-,,\( lAb r y , 20W. 1.1
<br />
<br />J~tNi~f rVll;.~ prl~t ~ ~y~e{~~~.~~dl~it~) J'L.71~ {-
<br />
<br />Sworn to and subscribed before me this "1-11;, day of i=e.bru Ii <'" , 20,\!!. t ;J.
<br />g/' Personally Known OR f
<br />Jj Produced Identification : Type of Identification
<br />
<br />~LJ': ':E. J-l-l:,AJ!-UO
<br />
<br />NOTARY PUBLIC STATE OF FLORIDA
<br />
<br />
<br />DECEMBeft2B,2010
<br />
<br />50f7
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