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SVNN, ,,„, CONFLICT OF INTEREST
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<br /> City of Sunny Isles Beach
<br /> l}`0 i- ,;Cy. 70
<br /> '` = 18070 Collins Avenue
<br /> '
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<br /> • rye Sunny Isles each,FL 33160
<br /> -, •.D - Telephone:(305)947-0606 Fax:(305)949-3113
<br /> yf 9'•FLOP\ 4.
<br /> c T r of SUN rNo 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 1)/t V, l
<br /> BEFORE ME,the undersigned authority, personally appeared , ail kr ,
<br /> who was duly sworn,deposes,and states:
<br /> 1. I am theCs�.7e ,/�Gisia 4,— of V/S%o4cdoexael e�Xa ( 2'"5 with a local
<br /> office in 7ietm 1 Ca,,-66/4..r / and principal office
<br /> i n \iden yr vi//e
<br /> 2. The above named/ entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. /;c//—d y-O/
<br /> described as-704, .rAma/7a57v7/4, A%oS4c ti--coPia.c.ce, s . 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 /> 411 4. 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 /> Date his /tP day of /1'Gt y /' , 20/>.
<br /> AFFIANT / Print or Type Name andtle
<br /> Sworn to and subscribed before me this 1 e day of 140.4 ,20 ll.
<br /> a Personally Known,OR
<br /> ® 0 Produced Identification-Type of Identification
<br /> NOTARY PUBLIC STATE OF FLORIDA x,;('54},,`1 - _sin ivied
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