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FORMS + ATTACHMENTS©
<br /> Professional Architecture Services for Government Center Lobby+Gateway Park
<br /> � JN-•4. e.� rS ..%'.'„
<br /> ' CONFLICT OF
<br /> • F INT
<br /> EREST
<br /> Cityof Sunny Isles Beach
<br /> u_ A' " - =)
<br /> 18070 Collins Avenue
<br /> II
<br /> • Sunny Isles each,FL 33160
<br /> ; ,� oyPS4.
<br /> �r.FlO�\ Telephone:(305)947-0606 Fax:(305)949-3113
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<br /> sE c'''')"OF SUN O'''' 1
<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 /> i. employee of the City of Sunny Isles Beach or its agencies.
<br /> STATE OF FLORIDA
<br /> COUNTY OF MIAMI DADE
<br /> BEFORE ME,the undersigned authority, personally appeared Young Song ,
<br /> who was duly sworn,deposes,and states:
<br /> 18.1. I am the President of Song+Associates with a local
<br /> office in West Palm Beach and principal office
<br /> in West Palm Beach .
<br /> w.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 17-12-01
<br /> described as
<br /> Professional
<br /> and atArchitectural ak foriInternal Spare Remodeling at Government Center The Affiant has made diligent
<br /> inquiry and provides the information contained in this Affidavit based upon his own knowledge. ,
<br /> 1.8.3. 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 /> 1.4.:.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 /> :1.x.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 /> 1.8.6. 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 /> 11. .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 /> :4``>.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 /> :i a:.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 day January ,2018 .
<br /> Young Song, President
<br /> AFFIANT Q, Print or Type Name and Title
<br /> Sworn to and subscribed before me this t/ day of 1 � 201�.
<br /> Personally Known,OR
<br /> ry 9
<br /> 0 Produced Identification -Type • ientific `4�.:• '.*4ej s Per Douglass
<br /> if?. ,., r. Commission#F 7812
<br /> NOTARY PUBLIC STATE OF FLORIDA .�. ".-r...,-..:•::--
<br /> ,.,,,,,,,
<br /> :-��;• Expires: May 1, 2020
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<br /> 5 - 7 r
<br /> 1 SONG + ASSOCIATES 73
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