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USN <br /> NY NSiF <br /> .n'._' CONFLICT OF INTEREST <br /> City <br /> of SunnyIsles Beach <br /> -,.�.�z-,•• <br /> : j 18070 Collins Avenue• <br /> .e. -ijo 2,.,F.LpP, S. Sunny Isles Beach,FL 33160 <br /> �''°;ok sv ,"- " Telephone:(305)947-0606 Fax:(305)949-3113 <br /> CONFLICT OF INTEREST STATEMENT . <br /> The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must <br /> disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the <br /> City of Sunny Isles Beach or its agencies. <br /> STATE OF FLARI A . <br /> COUNTY OF inicuw OLP ' <br /> BEFORE ME, the undersigned authority, personally appeared NO J w <br /> Q 1.1/1V , who was duly sworn, <br /> deposes,and states: (, <br /> 1 .1. 1 a the r Po of <br /> 4 nie. with a local office in 1 ?Z� t5 A S�eie'1 and principal office in <br /> 11-401-se iFt <br /> 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. described <br /> as: Printing and mailing. The Affiant has made diligent inquiry and provides the information contained in this Affidavit <br /> based upon his own knowledge. <br /> 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has <br /> no financial interest in other entities submitting Bids for the same project. <br /> 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in <br /> any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for <br /> the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and <br /> execution of the Contract for this project. <br /> 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from <br /> participation in contract letting by any local, State, or Federal Agency. • <br /> 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any <br /> other clients, contracts, or property interests for this project. <br /> 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or <br /> actively seeking an elected position with the City of Sunny Isles Beach. <br /> 18.8 I,certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City <br /> of Sunny Isles Beach. <br /> 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will <br /> immediately notify theCity of Sunny Isles Beach. <br /> Da d this ( t.it6 day of ' .L,A16. 20. <br /> b it i . -..t" Y,, GeV <br /> ANI<I1A441 Print o Type Name and Title <br /> S o.rn to and•subscribed before me this ((44day of ',.., A ,2020. <br /> Personally Known OR <br /> O Produced Identification ; Type of h= tification ' i i . <br /> NOTARY PUBLIC STATE OF FLORIDA <br /> III <br /> duoxes, Notary Public State of Florida <br /> Kaney Ratteray <br /> +a t` My Commission FF 978529 <br /> ' O1 Expires 04/04/2020 <br /> DECEMBER 28,2010 <br />