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<br />CONFLICT OF INTEREST
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<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
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<br />CONFLICT OF INTEREST STATEMENT
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<br />I !)
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<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 />,)
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<br />STATE OF FLORIDA
<br />COUNTY OF Miami-Dade
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<br />BEFORE ME, the undersigned authority, personally appeared Richard B, Bochnovich, P.E,
<br />deposes, and states:
<br />
<br />, who was duly sworn,
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<br />18.1. I am the Senior Vice President
<br />Consultinq Enqineerinq & Science, InCwith a local office in Miami. Florida
<br />Miami, Florida
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<br />18,2. The above named entitv is submitting a Bid for the City of Sunny Isles Beach, Bid No, 11-11-02 described
<br />as: ~~~~v~g~n:n~~ng Servic.s 10 Design Slr..' & Draiang. The Affiant has made diligent inquiry and provides the information contained in this
<br />AffidaVit cased upon nls own Knowledge,
<br />
<br />of
<br />and principal office in
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<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.
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<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.
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<br />18.5 Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from
<br />participation in contract letting by any local, State, or Federal Agency,
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<br />18.6 Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of interest due to any
<br />other clients, contracts, or property interests for this project.
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<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,
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<br />,!
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<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,
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<br />18.91n the event that a conflict of interest is identifie~d'n e prOViSio~1seAices,), on behalf ~he above named entity, will
<br />immediately notify the City of Sunny Isles Beach, /t-dt'azL o;JJc,,?1A/V(/t{/VL/
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<br />Dated this 1 st day of December , 2011
<br />Richard B, Bochnovich. P,E, Senior Vice President
<br />AFFIANT Print or Type Name and Title
<br />
<br />S!uorn to and subscribed before me this J.2L day of December
<br />ILl Personally Known OR
<br />o Produced Identification ; Type of Id tification
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<br />,2011,
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<br />
<br />OMAVRA V. BERG
<br />
<br />
<br />v&r;
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<br />NOTARY PUBLIC STATE OF FLORIDA
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<br />DECEMBER 28,
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