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gJNNYLs.,, CONFLICT OF INTEREST <br /> 4".= Z City of Sunny Isles Beach <br /> ' 18070 Collins Avenue <br /> Sunny Isles each,FL 33160 <br /> c: Telephone:(305)947-0606 Fax:(305)949-3113 <br /> yF�.• '•FLOP\ `6 <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'Mei Lu cix <br /> COUNTY OF' 'Ca m C,irri\A, <br /> BEFORE ME,the undersigned authority,personally appeared --Yr, c- <br /> who was duly sworn,deposes,� <br /> and states: > <br /> 1. I am the: C.-10.A u.s.ve•k s'of cv3l I (..\14 / with a local <br /> office in 7 341? gleieri cbo•d. C} r 3p/ _Pfeil y k,oPC- 3101,7 and principal office <br /> in /(a e f " S3 Ne4.1.1a _(y y/0? r <br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach,Bid No. /7-0Y—DI <br /> described as ..taro•wbi‘aIno, To,x) M,, ltioskS . 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 /> S. 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 y7(„ day of (01.) ,20 f 2. <br /> g AFFI Print or Type Name and Title <br /> amen E wJ ,n,, <br /> .= ."1 Sworn to and subscribed before me this `LZ day of ► �'(4. ,20 1 T. <br /> co) <br /> in Personally Known,OR <br /> u c 0 Produced Identification-Type of Identification <br /> t/f=Ci • <br /> 10 NOTARY PUBLIC STATE OF FLORIDA �� <br /> Y <br /> 5 of 7 <br />