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<br /> <br />CONFLICT OF INTEREST <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br /> Telephone: (305) 947-0606 Fax: (305) 949-3113 <br /> <br /> <br />CONFLICT OF INTEREST STATEMENT <br /> <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 /> <br />STATE OF FLORIDA <br />COUNTY OF ___________________ <br /> <br />BEFORE ME, the undersigned authority, personally appeared _____________________________, who was duly sworn, <br />deposes, and states: <br /> <br />18.1. I am the _________________________________________________ of <br />__________________________________with a local office in _____________________________ and principal office in <br />_____________________. <br /> <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. ______________ described <br />as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this <br />Affidavit based upon his own knowledge. <br /> <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 />no financial interest in other entities submitting Bids for the same project. <br /> <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 />execution of the Contract for this project. <br /> <br />18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from <br />participation in contract letting by any local, State, or Federal Agency. <br /> <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 /> <br />18.7 I certify that no member of the entity’s ownership or management is presently applying for any employee position or <br />actively seeking an elected position with the City of Sunny Isles Beach. <br /> <br />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 /> <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 /> <br />Dated this _________ day of _____________________________________, 2010. <br />_________________________________ _________________________________ <br />AFFIANT Print or Type Name and Title <br /> <br />Sworn to and subscribed before me this _____ day of ______________________, 2010. <br />ˆ Personally Known ________ OR <br />ˆ Produced Identification ________; Type of Identification _________________________ <br /> <br /> __________________________________ <br />NOTARY PUBLIC STATE OF FLORIDA <br />DECEMBER 28, 2010 5 of 7