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`+JNN, ,s,, CONFLICT OF INTEREST
<br /> O ::.F
<br /> ® ' •
<br /> ();'. City of Sunny Isles Beach
<br /> '=` ' = 18070 Collins Avenue •
<br /> �` c,..,_,'
<br /> e; ; - Sunny Isles each,FL 33160
<br /> r ,D`7F ;/' 7 Telephone:(305)947-0606 Fax:(305)949-3113
<br /> Se )`FLO0. S
<br /> C'TY OF Sus 'sO
<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 }Uakki - bade.
<br /> BEFORE ME,the undersigned authority, personally appeared /t((GK'4&'- POZIt'.- ,
<br /> who was duly sworn,deposes,and states:>
<br /> 1. I am the I/j' of /3(1.161174e'''/A- St-44"a" SC12-vteerIAiwith a local
<br /> office in ,s tocei Fe— 33(CG. and principal office
<br /> in S/1Sf -e /140,-47 D4• /10 vc-S 1,A0 p . 310,3 .
<br /> •• 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. /7-0s_0 I
<br /> described as Cal w/De 6,4Fv4ScAPe A44- r1 ,-4Nce. Se WI cis . 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
<br /> named entity has no financial interest in other entities submitting Bids for the same project.
<br /> 4111 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
<br /> otherwise 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
<br /> of 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
<br /> employee 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 /> Dated this 21 41 day of Tn°_.i , 20 Li.
<br /> AA/G i. - Doz,c„. /c VP
<br /> AFFIANT Print or TypepName and Title
<br /> Sworn to and subscribed before me this 21 day of u, 1</ ,20 t 1 .
<br /> El/Personally Known,OR
<br /> Ill ❑ Produced Identification-Type ofIs ntification
<br /> NOTARY PUBLIC STATE OF FLORID iitil1 4 ,(. / ' ""-"%v'IT. MYLUM NGELA FF 913313
<br /> (/ / _*• , 1.1
<br /> -W� {af EXPIRES:August 26,2019 !
<br /> 5 of 10 '..fl,6:ci`o Boded Thru Notary Rex Underwriters
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