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a4s�N�.YYfs<F�� CONFLICT OF INTEREST <br />n City of Sunny Isles Beach <br />*t <br />`= 18070 Collins Avenue <br />1 * Sunny Isles each, FL 33160 <br />f.Pk 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 <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 � a� ECOUNTY OF <br />BEFORE ME, the undersigned authority, personally appeared ) ` v g�/`Lr ` hy/rH o " <br />l. <br />who was duly sworn, deposes, and states: <br />1. 1 am the C-0 N7 1?6 LLE -/Z of,360 Ett-7ERN PRS N7-AJ6 (_aAnPPtNV1al <br />--rkC- <br />office in /1/�I i� M ( A E and principal office <br />in <br />2. The above named entity is subm tting a Bid for the ity o Sunny Isles Beach, Bid No. 2z / 2 'a) <br />described as C i 77y 0111) F p�►/ 7 -/Nei V%LES 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 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 affiliates, 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 />Dated this day of -J-AP UARy 202-3 <br />�/wTHU N, U ti 7f?d LL <br />AFFIAQIT v v� " Print or Type Name and Title <br />Sworn to and subscribed before me this day of JA ti 64 RAY_ 2023. <br />Personally Known, OR <br />❑ Produced Identification -Type of Identification <br />_.►ar.. RodgerA.an <br />NOTARY PUBLIC STATE OF FLORIDA Xla; " <br />Notary Public <br />Comm# HH066017 <br />5 of 8 S�NQE 19�e Expires 11/22/2024 <br />