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Facility Name/Location <br />Miami - Sunny Isles Beach Finance (115902-001) <br />18070 COLLINS AVE, SUNNY ISLES BEACH FL 33160-2723 <br />Real Estate Conflict of Interest Certification <br />County: Dade <br />Lease: Q90000541565 <br />To avoid actual or apparent conflicts of interest, the United States Postal Service ("Postal Service") requires the <br />following certification from you as a potential Landlord/Licensor/Supplier/Contractor to the Postal Service. Please <br />check all that apply in item A below. Further, please understand that the Postal Service will be relying on the <br />accuracy of the statements made by you in this certification in determining whether to proceed with any possible <br />transaction with you. <br />I, Nit S� v ti >u.t� � b hereby certify to the Postal Service as follows: <br />[PRINT: name 6f potential Landlord/Licensor/Supplier/Contractor] <br />A. (Check all that apply) I am: <br />(i) A Postal Service employee; <br />(ii) The spouse of a Postal Service employee; <br />(iii) A family member of a Postal Service employee; (Relationship) <br />(iv) An individual residing in the same household as a Postal Service employee; <br />(v) I am one of the individuals listed in (i) through (iv) above AND a controlling shareholder or owner of a <br />business organization leasing or licensing space or intending to lease or license space to the Postal <br />X <br />ce; OR <br />(vi)None of the above. <br />B. (Complete as applicable): <br />I. I have the following job with the Postal Service: <br />(Title) (Location) <br />ii. My spouse who works for the Postal Service holds the following job: <br />(Title) (Location) <br />iii. My family member who works for the Postal Service holds the following job: <br />(Title) (Location) <br />iv. My household member who works for the Postal Service holds the following job: <br />(Title) (Location) <br />C. If you have checked "none of the above" and during the lease or license term or any renewal term, you do fall <br />into any of the categories listed in A (i) through (v) above, you shall notify the Postal Service's Contracting Officer in <br />writing within 30 days of the date you fall into any of the such categories and shall include an explanation of which <br />of the above categories now applies. <br />D. The person signing this certification has full power of authority to bind the potential Landlord/Supplier/Contractor <br />named above. <br />August 2017 Page 1 of 2 <br />