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COIVrLIC 1 Ur 1N 1 txta 1
<br />t� `• o City 4T Sa-rry i,le� Bcacn
<br />18070 Collins Avenue
<br />Sammy Lyle: —ch, FL 33160
<br />rR`T Tel.phonc (30,);..; aoao rax (5a-,)5.e-3,7L:a
<br />F =� CONFLICT OF INTEREST STATEMENT
<br />I Mc a-.ra at 6ny eontroet nereenaer i3 ,an;eet to tRe pravi,ion3 of CR.ptcr 111, Florida State Statutes. Proposers
<br />n—,e,t ai;eles -itR tncir Bid3, tRe n.rmc at any att,cer, aircdor, partner, associate or agent who is also an officer or
<br />cmployec of tnc City at 5anny IIIc. Beocn or its agencies.
<br />STATE OF FLORIDA
<br />COUNTY OF - fXL
<br />BEFORE RAE, the undersigned authority, personally appeare'o
<br />wRo was Duly sworn, 'deposes, anO states:
<br />�r
<br />orrice in
<br />in
<br />YYitn a local
<br />and principal office
<br />2. The above named entity is submitting a Bid for the City of sunny Isles BeacR, oiD Mo.
<br />described as% +t 'i j t�ft8p8pi Ras ma'oe Ililigent
<br />inquiry and provides the information contained in LMis mffiUavit BaseD upon Mis own Rnowieage.
<br />I. I Ile muiant states Enat oar, enc-93rssit1..l to.- tR� o50.c Bia i, n -int ,05nsittca Ona tRot the a5owe
<br />norncD entity R., no tinonei-1 intcrc,t in atficr cntitie3 sa5rtsittins Bias for the same project.
<br />4. Neither the Affiant nor Lhe above named entity has directly or indirectly entereO into any agreement,
<br />paFticipated 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. i his statement restricts Me Discussion or pricing Bata until Elle
<br />completion of negotiations if necessary anD execution or we Contract Tor this project.
<br />]. Meitner Mc r --tit, noi7 ita 4ttiliote,, nor-nyone —3aciotea witn tncm, i. p,cacntly sespended or
<br />WERemi.-c inelirinlc tons p.Fiicipi-.tian in contract lettin6 5y any tocol, State, or Federal Agency,
<br />6. Neither the entity, nor its affiliates, nor anyone associated with them (lave any potential conflict
<br />of interest due to any other client, contract,, or properTy interests for Lnis project.
<br />1. 1 cerdTy tRat no mem5er of die entity's a :nc;75Rip or FM5Mu5cRlc..t i.. Areae„ tly applyins for any
<br />employee position or a.dzal, ,erlZh.15 on elcctea pa3it;o;-, 7,itR tRc City at Snnny Isic. Beach.
<br />8. 1 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 />V. In Me event T.MaL a conrlict or interest is iDendriea in the provision or sc : ivc,, I, en 150.1T er tRe .,607e
<br />nameD entity, will immediately notify the City or Bunn, Isles Beoclii.
<br />0-tca tRis a t ,_ 1 % 20 .
<br />AFFIAN Fruit or i ype Mame and t i tle
<br />orn to and subscribed before me this _.. may or
<br />5
<br />Fersonally Rnown, OR
<br />0 Firviiecen lac.-,tirie.,tic- - I ype or IacntiTication
<br />NO i Tiny PDQ[iC a i m t I! UP PLOR113m U N-0 L.IPLIW &Y4-111 AMY JEAN HOFFMAN
<br />V Commission M FF 990214
<br />Lukes' La5�i1$a in Inc. My Comm Expires Apr 19..020
<br />P g: %.� Banded through Nalronai Notary Assn
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