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"t" J14: <br />;OBJ' � _ . �ti`'• �.' <br />CONFLICT OF INTEREST <br />City of Sunny Isles Beach <br />'.� br 1 W70 C.,a6n {4veaus <br />5• C, �� • . a O �' aF t%r &"V IaLw Aea�tk Fl 3.3 tOO <br />r• o, ,�� " Y ` : (345)347-OSM Fax (3Gi) 949-3$13 <br />CONFUCT OF INTEREST STATEMENT <br />The award of any contract hereunder is subject to the provisions of Chilpter 117, Flariaa State Statuses- Proposers .Y VS( <br />disdose wish ftir 81¢s, the name of any officer, dire#ar, partner, associate or agent who is also an officer or emplarlee of the <br />City of Sunny Istel Beach or its agencies, <br />STATE OF FLORIDA <br />COUNTY OF errwd <br />RFFORE hfE, the unr±er5igned authority, personally appeared Mason R- Wells who was duty swo n. <br />deposes, and stakes: <br />18,1. 1 am the 'resident of <br />.lacey Imp wwnts, L.L.C. dtka+a Eke Tent Compan"sirfth a local ofFiCe In VVVSt Perk. FL and pdridpal affrce in <br />10,2, The above clamed entity is submitting a Bid tot the City of 5unrty Isles Beed. Bid Na. desaibed <br />as: Landscape Maintenance Services. The Affiant has made diligent inquiry and prgvides the information Gtiriained in this <br />Affidavit based upon hie own knoWedge. <br />18.3 The Affiant states ftt Drily one submittal for the above Bid is being submited and that.the above named entity, has <br />no irnan al irterasl in other enttties submitting Bids for the same project. <br />18.4 Neither the Affiant nor late above named entity+ liar, directly or indirectly entered into any agreerneret, par 6apated 41 <br />any e d lesion, or othenvise taken ".action in rfftraints of kee c ompeWve prang to o4rinection with the entity's suhmuttat for <br />tha agave Sid. This statement restricts the diswssion of pricing data until Ute complei;an of negoeatfuns if necessary and <br />eKewf n at the Contract for this prrApct. <br />18.5 Wither the en*- nor its affiliates, nor arry one assotzatecl wish them, is presently suspended or ottlerMse ineli€gibte f ofu <br />participation In wntradl letting by any local. S1ata, or Federal Agency_ <br />18.6 Neither the entity, nor its affiliate-, nor any one associated with them have any potential conflid of interest due to any <br />other elmrits, oor+#mm, or property in±erests for ibis pmjeeL <br />16,71 cartify that vo mernber of the entity's o*nershlp or management is presently appMng for any errpt ee position lir <br />dva>'r seeldq an elected pos+ikn With the City of Sunny Isles Beach. <br />18.8 1 ceFtffy that no morntw of the entity's i ymership or management, or staff has a vested interest in any 8"dil of the Gray <br />of Sunny Isles Beach. <br />18.9 In t40 agent that a c>iiitf _{jrateWt is id8nffied in the provision or services, I. on behalf of the above named entity, dil <br />wi6 .X14, <br />Ft. u*4-, r-wvrq <br />Pnrtt or Type Name and Tile <br />ApNM to and svbscntwdi pof0M nae this _2aEd day of UOuSL-201$ zoo. <br />Personally KnaNn .OR <br />Produced Itlantifrcatlon Type Df ldentl6catlon -- _-- <br />(VOTARY PUS - - - - - - &L z b�JA Ai.y� <br />Y��4l$CN E <br />r241i5T <br />XPIR9SJU4206, <br />�+ir13't��sir8 FF�r1;�� <br />cis NR02e, ni;a 5 of 7 <br />