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<br />( <br /> <br />. <br /> <br />SECTION 19 <br />CONFLICT OF INTEREST STATEMENT <br /> <br />STATE OF FLORIDA <br />COUNlY OF miAmI - DAD~ <br /> <br />BEFORE ME, the undersigned authority, personally appeared j,V <.J <br />was duly sworn, deposes, and states: n <br />19.1. I am the Gf.(I/~(}A\. ~N4<.t:" <br />a local office in (VII p. m I I F- L. and principal office in <br />I <br /> <br />?'E.rJ l"i f Z <br />of "ILA <J5 ~N tltrl~ihith <br />HO{flE.~it;AO, ft.. . <br />, <br /> <br />. who <br /> <br />19.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 08-10-01 <br />described as: SR A1NCollins Avenue Streetscape Improvements. <br /> <br />19.3. The Affiant has made diligent inquiry and provides the information contained in this Affidavit <br />based upon his own knowledge. <br /> <br />19.4. The Affiant states that only one submittal for the above bid is being submitted and that the <br />above named entity has no financial interest in other entities submitting bids for the same project. <br /> <br />L. <br />~ <br /> <br />19.5. Neither the Affiant nor the above named entity has directly or indirectly entered into any <br />agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive <br />pricing in connection with the entity's submittal for the above bid. This statement restricts the discussion <br />of pricing data until the completion of negotiations if necessary and execution of the Contract for this <br />project. <br /> <br />19.6. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or <br />otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. <br /> <br />19.7. Neither the entity, nor its affiliates, nor anyone associated with them has any potential conflict of <br />interest due to any other clients, contracts, or property interests for this project. <br /> <br />19.8. I certify that no member of the entity's ownership or management is presently applying for any <br />employee position or actively seeking an elected position with the City of Sunny Isles Beach. <br /> <br />19.9. I certify that no member of the entity's ownership or management, or staff has a vested interest <br />in any aspect of the City of Sunny Isles Beach. <br /> <br />19.10. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the <br />above named entity, will immediately notify the City of Sunny Isles Beach. <br /> <br />Dated this <br /> <br />% 7f.l day of <br /> <br /> <br />C' <br /> <br />AFFIANT Print or Type <br /> <br />~Swyrn to and subscribed before me this -$1H day of .DE.CF:.M f>E-f{ <br />~ Personally Known OR <br />o Produced Identification ; Type of I tific. n <br /> <br />'" #' JAY ZWELLING <br />l ":w""":. MY COMMISSION # DD639758 <br />~r:r, EXPIRES: June 27, 2011 Co <br /><>.;;"'....:/ F\. NOWY Discount As=. . <br />HlOO-3-NOTARY <br /> <br />.200E' <br /> <br /> <br />PAGE 80 OF 130 <br />BID No. 08-10-01 <br />