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<br />
<br />CONFLICT OF INTEREST
<br />
<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 />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 b /I
<br />COUNTY OF - ao:.e..-
<br />
<br />personally appeared (')f-I-A-",\~SO M17nl~~)/,(J 0
<br />
<br />\1 ?,'l=Ood SeeUI{'.a~ j)(Jj"S; oJ
<br />a local office in H WiGl i ;~D6) at?0-
<br />
<br />, who was duly sworn,
<br />
<br />BEFORE ME, the undersigned authority,
<br />deposes, and states:
<br />
<br />18.1. I a~1 ,t' the
<br />.US wroup, Ur/ d/~t1c..1f65id1\-rc.~ISwith
<br />1-1 WJ('()I l~lHl'tlt'L....-
<br />
<br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. /;;2..-1.)3 -02. 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 />of
<br />and principal office in
<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 anyone 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 anyone associated with them have any potential conflict of interest due to any
<br />other clients, contracts, or property interests for this project
<br />
<br />18.71 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 />
<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 />JI~1 , 'NL ~
<br />day of ' , 201 if. I C' _ .
<br />I ORlllrNdv MOt) 'z:a<jlt D , V P,1=VlX: 2(,:'(L\"C-i'S
<br />!Yo Print or Type Name ancfTitle
<br />
<br />Sworn to and subscribed before me this ~ day of /.J;/VL , 201p?-
<br />0/,' Personally Known OR,' -
<br />" Pcoduo.d Id.ot;oo.';oo ; Typ. of 1doo"oa';00 Mi
<br />
<br />
<br />NOTARYPUBLlcs~!nf~
<br />"tJ" Notary Public State of Florida
<br />l ~ Isbel Ramos
<br />.. My Commission EE130802
<br />,.}$ Expires 09/16/2015
<br />
<br />
<br />
<br />DECEMBER 28, 2010
<br />
<br />5 of 7
<br />
<br />5L.5 lOrD eLf I LL~_ ct{ 61 d- Q. {-ASSJe-
<br />
<br />~~'f,rf~'~
<br />'R'F'P NO-: 12-(.1::5-02-
<br />
<br />pc~30
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