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<br /> ,�` °rFCONFLICT OF INTEREST
<br /> Qt $o ��
<br /> ;" S ‹ City of Sunny Isles Beach
<br /> = ' 18070 Collins Avenue
<br /> nSunny Isles each,FL 33160
<br /> �rao Telephone:(305)947-0606 Fax:(305)949-3113
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<br /> f� 1.vCOR'. c:,.1.,ly PF£•+"tr
<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 FL DA
<br /> COUNTY OF, ccc
<br /> BEFORE ME,the undersigned authority, personally appeared M kCJ1tOL A pot-�e7 ,
<br /> who was duly sworn,deposes,and states:
<br /> 1. I am the-TC--e k ,-e(S\ of L(� 5' \ ('\,5c,c)1N3 r LN_with a local
<br /> office in -Dink e BCCI)Om ' -L. . and principal office
<br /> in 1J O(\\ C)-- _Q r L. .
<br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. I V 03-03
<br /> described asVickr & Sarc'tC.i1tile 5 c as('A e.)4n114-M( cgThe Affiant has made diligent
<br /> inquiry and provibes the informs ion 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
<br /> named 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
<br /> otherwise 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
<br /> of 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
<br /> employee 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 immediately notify the City of Sunny Isles Beach.
<br /> Dated this 1 p dayof 1 120`�
<br /> A /\‘‘ Cry k Por s, e5\C\e M
<br /> AFFIAN,,��
<br /> � Print or Type Name and Title
<br /> Sworn to and subscribed before me this 1 Y day of 4sv- , 1 ,20 ti.
<br /> . Personally Known,OR .
<br /> 0 Produced Identification-Type of Identification �yy
<br /> NOTARY PUBLIC STATE OF FLORIDA ailiti-- `�� I Ii ,� YPAMY JOAN II0rIMAN
<br /> ,R
<br /> :°,�,% Notary Public•State of Florida
<br /> 5 of 10 •: '•` ••: Commission # FF 980214
<br /> Lukes' Landscaping , . o My Comm.Expires Apr 19, ,320
<br /> „Or',,,,,,,`` Bonded through National Notary Assn.
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