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SJNNYrs4, CONFLICT OF INTEREST
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<br /> a Car\n City of Sunny Isles Beach
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<br /> • ti18070 Collins Avenue
<br /> -�-- : Sunny Isles each,FL 33160
<br /> , •cy "•t e-, Telephone:(305)947-0606 Fax:(305)949-3113
<br /> SF 7• FLOc•\O ytc
<br /> 'Tr OF SUS r'''
<br /> CONFLICT OF INTEREST STATEMENT
<br /> The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers
<br /> must disclose with their Bids,the name of any officer,director,partner,associate or agent who is also an officer or
<br /> employee of the City of Sunny Isles Beach or its agencies.
<br /> STATE OF FLORIDA
<br /> COUNTY OF iggOW47.Q
<br /> BEFORE ME,the undersigned authority, personally appeared 72E'1"Oh/-4-Lr—os 4') ,
<br /> who was duly sworn,deposes,and states:
<br /> 1. I am the ,Of& eT3✓e of $11L. S with a local
<br /> office in 41//204/C(/gfe / Fes'/Dl•L and principal office
<br /> in iA/i2.4 £IA / /cLO/LiO.4 .
<br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. /7—N-- P
<br /> described as -fNFoeMAT1oN 7D(/Lt{,$Q`f6eAJ KID S:CS . The Affiant has made diligent
<br /> inquiry and provides the information contained in this Affidavit based upon his own knowledge.
<br /> 3. The Affiant states that only one submittal for the above Bid is being submitted and that the above named
<br /> entity has no financial interest in other entities submitting Bids for the same project.
<br /> III4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement,
<br /> participated in any collusion,or otherwise taken any action in restraints of free competitive pricing in connection
<br /> with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the
<br /> completion of negotiations if necessary and execution of the Contract for this project.
<br /> 5. Neither the entity nor its affiliates,nor anyone associated with them,is presently suspended or otherwise
<br /> ineligible from participation in contract letting by any local,State,or Federal Agency.
<br /> 6. Neither the entity,nor its affiliates, nor anyone associated with them have any potential conflict of
<br /> interest due to any other clients,contracts,or property interests for this project.
<br /> 7. I certify that no member of the entity's ownership or management is presently applying for any employee
<br /> position or actively seeking an elected position with the City of Sunny Isles Beach.
<br /> 8. I certify that no member of the entity's ownership or management,or staff has a vested interest in any •
<br /> aspect of the City of Sunny Isles Beach.
<br /> 9. In the event that a conflict of interest is identified in the provision of services,I,on behalf of the above
<br /> named entity,will immediately notify the City of Sunny Isles Beach.
<br /> 9
<br /> Dates hi. , day .f PA7/ , 20 17 pt ege—izq
<br /> .,./L .1w ._L � e O'Fhtc.o e�7 OC- S �s
<br /> AFFIA I Print or Type Name and Title
<br /> Sworn to and subscribed before me this / 9 day of glCc_j , 20/ 4....
<br /> Personally Known,OR /
<br /> III ❑ Produced Identification-Type of Identification __�•.r. r..t-.._,-...._....,...,...._^._.,0
<br /> ' ��� ski, RONALD STERLING ANDERSON �- _.-
<br /> NOTARY PUBLIC STATE OF FLORIDA (% '--- ?i'`� B`� Notary Public •State of Florida
<br /> ' ; . .•_ Commission* 746
<br /> 'N' 11111,,, � MyComm.Expires Nov 14.2020,
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<br /> 5 of 7 Bonded through National Notary Assn.
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