Laserfiche WebLink
. <br /> I <br /> /Q iSVyN :.•nJ • CONFLICT OF INTEREST <br /> ,- :a," City of sunny Isles Beach <br /> G - i'-7: r. c <br /> ; . 18070 Collins Avenue <br /> ;= • Sunny Isles each,FL 33160 <br /> • <br /> .,,-.7--- . Telephone:(305)947-0606 Fax:(305)949-3113 <br /> 'Se C'➢'•FI0 C'S V' <br /> �r SUN ''''° <br /> r 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 /> Iemployee of the City of Sunny Isles Beach or its agencies. <br /> STATE OF FLORIDA <br /> I COUNTY OF <br /> BEFORE ME,the undersigned authority,personally appeared Kristy Fuentes <br /> who was duly sworn,deposes,and states: <br /> 1 1. I am the VP/Secretary/Treasurerof DRC Emergency Services, LLC with a local <br /> office in West Palm Beach.Florida and principal office <br /> 1 in Galveston.Texas <br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 18-04-02 <br /> described as Disaster Debris Management and Disposal services . The Affiant has made diligent <br /> Iinquiry 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 /> I4. 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 /> I 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 /> I7. 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 /> 1 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 /> 1 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 /> Date t'is 'Sg..... ,of ir1t� , 20 i <br /> I / ' , /) Kristy Fuentes VP/Secretary/Treasurer <br /> AF A / �-c ,/ Print or Type Name and Title <br /> Sworn to and subscribed before me this 7S --e---7-- <br /> day of J21 <br /> IR Personally Known,OR = <br /> o Produced Identification-Type of Identification . - <br /> % "-"GARY A. DES ROCHES <br /> NOTARY PUBLIC STATE OFF RIDA . <br /> inky'ARV 1-7UoLw <br /> 5 of 1oState of Louisiana, Bar No. 19550 <br /> My Commission is for life <br /> 119 <br />