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171 <br />pk SV N N Y 's<E�B <br />CONFLICT OF INTEREST <br />' City of Sunny Isles Beach <br />18070 Collins Avenue <br />• F l0 h4� Sunny Isles Beach, FL 33160 <br />0 ", or , .N ►`O Telephone: (305) 947 -0806 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 <br />BEFORE ME, the undersigned authority, personally appeared <br />Charles Gusmano who was duly sworn, <br />deposes, and states: <br />18.1. J am the Member / Manager of <br />Southern Waste SystemsNith a local office in and principal office in <br />11 -01 -01 <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 />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 />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 />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 />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 />actively seeking an elected position with the City of Sunny Isles Beach. <br />18.81 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. 2011 <br />Januar - <br />1 S t day of 2010. <br />ar es Gusmano Member/ Manager <br />Print or Type Name and Title <br />Sworn to and subscribed before me this 31s tay of January, 2 011 X <br />IXX Personally Known OR <br />O Produced Identification ; Type of Identificati n <br />NOTARY PUBLIC STATE <br />OP <br />,'rOF Fly <br />OF FLORIDA <br />KATHLEEN A. SASS <br />.1y COMMISSION # DD 6MIa <br />EXPIRES: June 22, 2011 <br />Bonded Thru Budget tlamt' SW4M <br />0 DECEMBER 2a, 2010 5 of 7 <br />