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CONFLICT OF INTEREST <br />City of Sunny isles Beach <br />F 18070 Collins Avrtue <br />Sunny Isles each. Fl, 33160 <br />'ter • p • Telephone (345) 947-0606 Fax: (305) 949-3113 <br />y� <br />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 r, 1 <br />COUNTY OF My <br />EQ'1tA-_ <br />BEFORE. ME, the undersigned authority, personally appeared <br />who was duly sworn, deposes, and states: <br />1. l am the fe . LAerr) of with a local <br />office in CAL and principal office <br />in i"� s -S 1(-L- <br />2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 2 Z - 03 - n 1 <br />descnbed as C l_ k. '1-0141 12'AZ k_ 1i�AL- The Affiant has made diligent <br />inquiry and provldes 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 named <br />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, <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 afilhates, nor anyone associated with them, is presently suspended or otherwise <br />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 of <br />interest due to any other clients, contracts, or property interests for this project. <br />7, 1 certify that no member of the entity's ownership or management is presently applying for any employee <br />position or actively seeking an elected position with the City of Sunny Isles Beach. <br />8. 1 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 />5 <br />Dated this day of 20L?,_ <br />j7res,i,�c�'t- <br />AFFIANT Print or Type Name and Title <br />5� <br />Sworn to and subscribed before me this _ day of 1'-1 fi rzG 20 ?-77 <br />❑ Personally Known, OR <br />%L—Produced Identification - Type ofJoentlfication C Lv/t-f d A rb ✓e oag; C'e'? <br />NOTARY PUBLIC STATE OF FILORIIDA <br />NORIIIERTO J PEAEZ-SoRROTO <br />l;, �rl 1"Vary Public - Stato Or F,V$gi <br />5 B "� d�' COMMinlOnIHHpCdlol <br />My Cmm- expires Jul 14, 2024 <br />