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CONFLICT OF INTEREST City of Sunny Isles Beach B LO '0 % aw ny Isle Bosch, FL 38180 or iuk "' Telephone: (805) 847.0008 Fax: (306) $4"13 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder Is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Side, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTYOF bAbC BEFORE ME, the undersigned authority, personally appeared Z,� who was duly sworn, deposes, and states: am of fr.� QTY r with a localoffice in and principal office in 18.2. The above named entity Is submitting a Bid far the City of Sunny Isles Beach, Bid No. described as: Landscape Maintenance Services, The Afflant has made diligent Inquiry and provides the information contained In this Affidavit based upon his own knowledge. 18.3 The Afflent states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entitles submitting Bids for the same project. 18A Neither the Afiiarit nor the above named entity has directly or Indirectly entered Into any agreement, participated in any colluslon, or otherwise taken any action In restraints of free competitive prtotng In connection with the entity's submittal for the above Bid. This statement restricts the discussion. of pricing data until the completion of negotiations If necessary and execution of the Contract for this project. 18.6 Neither the entity nor its affiliates, nor any one associated with them, Is presently suspended or otherwise ineligible from participation In contract lofting by any local, State, or Federal Agency. 18.8 Neither the entity, nor its attulates, nor any one associated with them have any potential conflict of Interest due to any other clients, contracts, or property Interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 46.81 certify that no member of the entity's ownership or management, or staff has a vested Interest In any aspect of the City of Sunny Isles Beach. 18,8 In the event that a conflict of interest Is Identified In the provision of services,, 1, on behalf of the above named entity, will Immediately notify the City of Sunny isles Beach. Dated this / ;Z- day of — AFFiANT n e- , 2010L Q r 2reS�o�»7� Print or Type Name and Title ` Sworn to and subscribed before me this � day of _ V n G 201.1 �t Personally Known OR O Produced Identification ; Type of idemmoation NbTART PUBLIC STATE OF FLORIDA Dscmi!R 28, 2010 �,...,....1,:•au.a,as.o-e' MARIA t3 Of tlasq ontlau • fArlplrss til3112043 8 or 7 ftida tlateryAW., Ina .'OaRORa6 Rl.+ eh • +•••H. +9Y4gRgqCpRORqqOqaqqtlR+