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CONFLICT OF INTEREST City of Sunny Isles Beach 1 B070 Collins Avenue Sunny Isles Beach. Fl 33160 Telephone: (305) 947-0606 Fax: (305) 949-3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF Florida BEFORE ME, the undersigned authority, personally appeared Pirooz Borojerdi deposes, and states: , who was duly sworn, 18.1. I am Tally Engineering, Inc. Pembroke Pines the President with a local office in Pembroke Pines of and principal office in 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 11-07-01 described as: Speeiallnspeetion Services Ine!. Geo/Const. Adml.n The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project 18.5 Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project 18.7 I certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 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 Cily of Sunny Isles Beach. 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 immediately n . the City of Sunny Isles Beach. July 2011 Pirooz Borojerdi / President Print or Type Name and Title Sworn to and subscribed before me this ~ day of 12! Personally Known OR o Produced Identification ; Type of Identification ~ ( ~/}IF-j/A lit.. July , 2011 NOTARY PUBLIC STATE OF FLORIDA .......... MARILYN MEDINA .wr.T "lIi>', .~~l:...i: l:. . }~ MY COMMISSION # EE 029888 ~. .~J EXPIRES: September 27,2014 "'t.r.P.r..f,.~,. Booded Thru Nolaly Public Underwritm DECEMBER 28,2010 5 of 7