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(18-04-01) North Bay Road Drainage Improvements
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All Webbs Enterprises Inc.
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Last modified
5/3/2018 9:25:57 AM
Creation date
5/3/2018 9:22:11 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
North Bay Road Drainage Improvements
Bid No. (xx-xx-xx)
18-04-01
Project Type (Bid, RFP, RFQ)
Bid
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ori Y /s4es, CONFLICT OF INTEREST <br /> .,-/ - 4 0 it, n City of Sunny Isles Beach <br /> G. :iv* s <br /> 18070 Collins Avenue <br /> + Sunny Isles each,FL 33160 <br /> a PP <br /> : Telephone:(305)947-0606 Fax:(305)949-3113 <br /> Q <br /> 'f',YD97w FLo0.` `, <br /> '"Y OF suo P''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 ?AL 'R '3E-ACR <br /> BEFORE ME,the undersigned authority, personally appeared U .1..O UG-b5 �9- <br /> Y 1 , <br /> who was duly sworn,deposes,and states: <br /> �\ CC E5IPE)T of ALL U1 EMS Co-r Eg'R-3- 6 7Nc <br /> 1. I am the V— 12 S_ with a local <br /> office in and principal office <br /> in 3 00 Cor•rAEPcE (AJicy -ree- FL 33'5 Tr q <br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. I 0 — O41'—0 I <br /> described as NJOR"(I'{ -5l44l Ro4D DIZAZpIACrE 1mA OV66nE,JT . 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 /> 4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, IP <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 �1-r17 day of A 1 p--=L ,20 le . <br /> .7.... .,.....1_,....„,,.._ <br /> AFFIANT Printnor Type Name and Title <br /> Sworn to and subscribed before me this 2-7 TH day of /4 Pie-zc_ ,20 )8 . <br /> n Personally Known,OR <br /> 0 Produced Identification-Type of Identification <br /> II <br /> NOTARY PUBLIC STATE OF FLORIDA / A 4'/ 4 . •LAS LEE <br /> Commission# FF 982474 <br /> es <br /> i"—!— ° MY Commission Exp <br /> 5 of 10 ,•,i.I i�PC <br /> '";A°4F�`pr Aprll 14, 2020 <br />
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