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0 Is rs <br /> o`�o <br /> ® n CONFLICT OF INTEREST <br /> 0 V I I. 2 <br /> `%- City of Sunny Isles Beach <br /> O 18070 Collins Avenue <br /> "v.�io�`o' Sunnylsles Beach,FL 33160 <br /> ® O, ,Y •� <br /> 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 FLORIDA <br /> COUNTY OF Palm Beach Lp� <br /> 0 BEFORE ME, the undersigned authority, personally appeared &r i11 _AS S S. R102O , who was duly sworn, <br /> deposes, and states: <br /> • 18.1. I am the Sole Owner / President of <br /> ® Stockton Maintenance Group with a local office in Palm Beach and principal office in <br /> Palm Beach <br /> • 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 15-07-01 described <br /> ® as: T8/fhe Affiant has made diligent inquiry and provides the information contained in this <br /> ® Affidavit based upon his own knowledge. City wide Custodial Services <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 /> O 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 /> 9 execution of the Contract for this project. <br /> 9 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from <br /> O 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 /> O actively seeking an elected position with the City of Sunny Isles Beach. <br /> 9 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 the City of Sunny Isles Beach. <br /> O '8 <br /> Da i of v` 7T , 2010.' <br /> 9 Doug Riordan, President <br /> ® AF ANT Print or Type Name and Title <br /> Sworn to and subscribed before me this `/ day of .t9.....o–Z ,20 <br /> ® 0 Personally Known OR <br /> ® 0 Produced Identification ;Type of Identification ., <br /> • / .2.“—_ S. -"r: <br /> NOTARY PUBLIC STATE OF FLORIDA <br /> • / <br /> Qr. ti.;.nA �rw.vvvNVfn:. <br /> ELAINE CO Iv10SCH .1'1 <br /> 0 UN MY COMMISSION 0 EEI7in..0 2 <br /> EAT^88:Marl Pl. 016 T <br /> • ` 1vb '"A 1)TASY • Nuy j <br /> 40 DECEMBER 78.2010 5 of 10 <br />