Laserfiche WebLink
SJNNy,s, _ CONFLICT OF INTEREST <br /> A F <br /> !-0 3 City of Sunny Isles Beach <br /> 'T1'--:.14:1---&'--..- I. <br /> 18070 Collins Avenue <br /> Sunny Isles each,FL 33160 <br /> •/'9+ Q`or SST Telephone:(305)947-0606 Fax:(305)949-3113 <br /> s <br /> FLO . <br /> c'','ci' sus ''s 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 a //��__ � <br /> COUNTY OF hA'CM' tctc a., t lirtil <br /> . BEFORE,ME,the undersigned authority,personaliy appeared GiQbri d� Q;ze,r,.9fl , <br /> who was duly sworn,deposes,� and states: .�� <br /> 1. I am the ?rtSithy\f of DISQ$-hex ProgrCM O�r44i4'1S nth vTiith a local <br /> office in 1o4 W '2.1511 or, ctt,�n'Gf4 C I VL. Y.303°4and principal office <br /> in 10023 SS2.► ffr-ca S' Tr. IM, '4..>.1.1.e._12..% `?cnOre-1►1Qctro_ Bea_cln. Ft. 3Z o <br /> 2. The above named entity itsssu�b�miitting a Bid for the City of Sunny Isles Beach, Bid No. 1g - ex.. --0% <br /> described as tSI 34- Cern iS ( kCart+-lcY►r -- . 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 /> 0111 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 /> 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 /> • <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 /> • <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 tify the City of Sunny IslesIsesBeach. <br /> Dated thisj day of I , 20 <br /> ' � • / abn e.0 e n 1 re.s0-W - <br /> FFIANT Print or Type Name and Title <br /> worn to and subscribed before me this74"21 day of A Aly ,20 41! <br /> ® <br /> Personally Known,OR / / <br /> O Produced Identification-Typ::.of Identification 4"; `SZ- ,Lr-Z4-2.67--.4e1/1Y0 <br /> NOTARY PUBLIC STATE OF FLORIDA ! '4,t. HASHAIH MORALES <br /> MY COMM H <br /> °�a EXPIRES: <br /> March <br /> h 30,2020 <br /> 5of10 -_-.- <br /> I <br />