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�SJNNY is4e CONFLICT OF INTEREST <br /> '=�'� City of Sunny Isles Beach <br /> _ - }` = 18070 Collins Avenue <br /> Sunny Isles each,FL 33160 <br /> ��� Telephone:(305)947-0606 Fax:(305)949-3113 <br /> ��FLO A'Or 4`7 <br /> c,T <br /> Y of si.o, <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 DADE <br /> BEFORE ME,the undersigned authority,personally appeared Allan Alcerro <br /> who was duly sworn,deposes,and states: <br /> 1. I am the Store Manager of The goodyear Tire & Rubber Company with a local <br /> office in 12850 West Dixie Hwy, North Miami,FI,33161 and principal office <br /> in 200 Innovation Way,Akron , Oh,44316-0001 <br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. <br /> described as . 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 /> 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 /> Dated this 05 day of september ,2017 . <br /> AFFIANT Print or Type Name and Title <br /> Sworn to and subscribed before me this day of , 20 .......... <br /> ❑ Personally Known,OR <br /> ❑ Produced Identification -Type of Identification <br /> NOTARY PUBLIC STATE OF FLORIDA <br /> 5 of 7 <br />