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. 5,",,,,„, CONFLICT OF INTEREST
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<br /> moi. ,,:( 4-4.-:. 4 City of Sunny Isles Beach
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<br /> •( 18070 Collins Avenue
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<br /> Sunny Isles each,FL 33160a � P Telephone:(305)947-0606 Fax:(305)949-3113
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<br /> S'f,C'''''''OF
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<br /> r*of "'O �� 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 ?ALP% 3€.AcR
<br /> �/� y , 3
<br /> BEFORE ME,the undersigned authority,personally appeared 'MV 10 W €7, ,
<br /> who was duly sworn,deposes,and states: Q
<br /> 1. I am the VS U IR€5IPENT of ALL UJ €3B S Co TEi title-TSC-$ 7wi h a local
<br /> office inand principal office
<br /> in Soo Cor•r•ERcE CJA-1 3-ve TEK !- L 3341 1r
<br /> 2.The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. ( $— 04-01
<br /> described as 1\10(2.11-( —64-1 RO4D DRAT/J/14E. Immov6nl en)T . 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, 410
<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 2-1 T / day of A?fl--=L ,20 18 .
<br /> - ----- .,.._1_,__>-V— .
<br /> AFFIANT Print or Type Name and Title
<br /> Sworn to and subscribed before me this 2-7 TH day of fI Ps-zc_ ,20 )8
<br /> personally Known,OR
<br /> ❑ Produced Identification-Type of Identification
<br /> NOTARY PUBLIC STATE OF FLORIDA , ./ .t. LAS LEE
<br /> ;5)1-Vs, Commission# FF 982474
<br /> Commission Expires
<br /> ��i:i.i*"i city 2020
<br /> 5of10 IP` r Apt1114.
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