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0 <br /> ® S,NNY ii,, <br /> ® = ;; • CONFLICT OF INTEREST <br /> V fir'' 2 <br /> I -�G4y� <br /> ® •y - : City of Sunny les Beach <br /> ' 18070 Collins s Avenue <br /> ® it s, '•rro• o Sunny Isles Beach,FL 33160 <br /> o,r <br /> Os sus' Telephone:(305)947-0606 Fax(305)949-3113 <br /> ® CONFLICT OF INTEREST STATEMENT <br /> 0 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 /> ® <br /> City of Sunny Isles Beach or its agencies. <br /> ® STATE OF FLQQf�jff DA <br /> ® COUNTY OF tf QIYIIo That <br /> ® BEFORE ME, the undersigned authority, personally appeared i S44ier U week <br /> e e , who was duly sworn, <br /> deposes, and states: <br /> ® 18.1. I am the of <br /> with a local office in and principal office in <br /> ® 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. ( 2-_I0_°1described <br /> as Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this <br /> 5 Affidavit based upon his own knowledge. <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 /> q 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in <br /> a 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 /> ® 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from <br /> ® participation in contract letting by any local, State,or Federal Agency. <br /> 0 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any <br /> 1110 other clients,contracts, or property interests for this project. <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 /> ® 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 Isles Beach. <br /> IL <br /> Date . d9y f L)r <br /> (At/LL ci ES�h er U f f e 2Q4V <br /> ® AFFIANT Print or Type Name and Title Z0/2r <br /> ® Sworn to and subscribed before me this n day of 7.-"EC. ,21311r <br /> O Personally Known OR <br /> ® <br /> 1 Produced Identification ✓ , Type of Identification 4tL A}1 <br /> 40 NOTARY PUBLIC STATE OF FLORIDA - <br /> cRANKUNa00etot0003 <br /> ,,t'a:.s.a, 6732 <br /> ® ?� a•C� ,10n �D3M1 t,2013 <br /> ® I . <br /> M <br /> ® DECEUaER 28,2010 50f7 <br /> le <br /> • <br />