Laserfiche WebLink
0 <br /> 0 <br /> 0 <br /> 0 NLIY;s CONFLICT OF INTEREST <br /> ® 1.- ". <br /> -3.s��9 <br /> City of Sunny Isles Beach <br /> ® `= 18070 Collins Avenue <br /> i xj-: <br /> ® %.:.7--„ti:".:'`... Sunny Isles each,Fl 33160 <br /> ➢ _ � Telephone:(305)947-0606 Fax:(305)949-3113 <br /> c, <br /> T`Gc SUN P' <br /> 0 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 N 1 i.M i 1)6-+=4-2 <br /> ® BEFORE ME,the undersigned authority,personally appeared 1-T 1rrY,"4-hy bC.,1` <br /> 9-0S <br /> ® who was duly sworn,deposes,and states: L <br /> 0 1. I am the V P of rYb1AJr1 1-01.0i1-1,1CC3TY1eiIwith a local <br /> office in NmQ — 3Ca3 Nw trIOSi NOTVA t((11\-16 Vgy�t R.. 3311Dand prirScipal office <br /> in I4S I tKI ) 20 5h 1`'11 ant-r % , 3B14a <br /> 0 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach,Bid No. 1 el — 1 I —0 I <br /> described as Tell-L1-95+ .Fc3-. bra 5=t 1 . The Affiant has made diligent <br /> inquiry and provides the information contained in this Affidavit based upon his own knowledge. <br /> 0 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 /> ® 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 /> 0 aspect of the City of Sunny Isles Beach. <br /> O 9. In the event that a conflict of interest is identified in the provision of services,I,on behalf of the above <br /> 0 named entity,will immediately notify the City of Sunny Isles Beach. <br /> Dated this �i� /y PCC' id .612- . ,20 17 . <br /> ® f /, Ti ti P 1 <br /> ® AFFIANT <br /> id <br /> Print or Type Name and Title <br /> 444 <br /> . Sw9rn to and subscribed before me this 6 ` day of 'D ECE H 6E 2 ,20 I, . <br /> rIff Known,OR <br /> ❑ Produced Identification-Type of Ide 'fication <br /> 0 <br /> ItAk 1 <br /> ® NOTARY PUBLIC STATE OF FLORIDA 'at.i� 1 <br /> s; lei ... MY COMMISSION#FF 191639 <br /> ® 5 0 7 T EXPIRES:February 26,2019 <br /> O 7'f,',od....•' Bonded Thu Notary Pub§c Undeiwrilers <br /> ® i <br /> 40 <br />