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F15\ CONFLICT OF INTEREST
<br /> 7,„;:;--.),.Ny
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<br /> _� �, City of Sunny Isles Beach
<br /> 0 U5 { {, '1-';'/, 18070 Collins Avenue
<br /> Sunny Sunny Isles each,FL 33160
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<br /> r Telephone:(305)947-0606 Fax:(305)949-3113
<br /> tiF�, 91`_F LOP\O.O"
<br /> TY OF SUN �"
<br /> CONFLICT OF INTEREST STATEMENT
<br /> The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers
<br /> must disclose with their Bids,the name of any officer,director, partner,associate or agent who is also an officer or
<br /> employee of the City of Sunny Isles Beach or its agencies.
<br /> STATE OF FLORIDA
<br /> COUNTY OF /4/1AuR/ •r44;fr•E
<br /> BEFORE ME,the undersigned authority, personally appeared 44.2ky 51:1/1424u l4' ,
<br /> who was duly sworn,deposes,and states: ,�
<br /> 1. I am the P st3 e�� of A4J,�Q.. 1.:40 +tPC,ViA/0... ./fOg -w t al
<br /> office in jlOk.T K P1'Aw4i 3CA a.44 , PL- and principal office
<br /> in M/4M. , iL• .
<br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No.RJ%p JIG, Ii-f{-D j
<br /> described as r-r45-€Aj/A a SC2v.e. 3 . The Affiant has made diligent
<br /> inquiry and provides the information contained in this Affidavit based upon his own knowledge.
<br /> 3. The Affiant states that only one submittal for the above Bid is being submitted and that the above named
<br /> entity has no financial interest in other entities submitting Bids for the same project.
<br /> 8 4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement,
<br /> participated in any collusion,or otherwise taken any action in restraints of free competitive pricing in connection
<br /> with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the
<br /> completion of negotiations if necessary and execution of the Contract for this project.
<br /> 5. Neither the entity nor its affiliates,nor anyone associated with them,is presently suspended or otherwise
<br /> ineligible from participation in contract letting by any local,State,or Federal Agency.
<br /> 6. Neither the entity, nor its affiliates,nor anyone associated with them have any potential conflict of
<br /> interest due to any other clients,contracts,or property interests for this project.
<br /> 7. I certify that no member of the entity's ownership or management is presently applying for any employee
<br /> position or actively seeking an elected position with the City of Sunny Isles Beach.
<br /> 8. I certify that no member of the entity's ownership or management,or staff has a vested interest in any
<br /> aspect of the City of Sunny Isles Beach.
<br /> 9. In the event that a conflict of interest is identified in the provision of services, I,on behalf of the above
<br /> named entity,will imme.'•tel i ,otify the City of Sunny Isles Beach.
<br /> Dated this iff iay of..1E-CFM IZ 20 (7.
<br /> Am�'�I� A/2/z/ ao ta-,��,sr>evT
<br /> AFFIANT II, Print or Type Name and Title
<br /> Sw�n to
<br /> I s •. bed before me this 1, day of .EC;. t BBQ ,20 17.
<br /> ' Perso ally nown,OR
<br /> 0 0 Produced Identification-Type of Identification Wette(',OfdOva
<br /> ����a���' mmiss• n#GG158933
<br /> NOTARY PUBLIC STATE OF FLORIDA Akin :� ,a : Co , .mfr 8,2021
<br /> x .;r . ; Pt aron NOIFY
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<br /> 5 of 70•
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