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SJNNY ,s4 CONFLICT OF INTEREST <br /> ( City of Sunny Isles Beach <br /> x 18070 Collins Avenue <br /> Sunny Isles each,FL 33160 <br /> .9 .. r Telephone:(305)947-0606 Fax:(305)949-3113 <br /> hF, 91* F L O p OF <br /> c T> SUN Pio 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 06 DY" ta� NAIL* <br /> • <br /> BEFORE ME,the undersigned authority,personally appeared Claws o� Q)f,nr9who was duly sworn,deposes,and states: <br /> 1. I am the 'PI2s'c r+ of tI$QS-kx ?Co rCM �rQk'G- S with a local <br /> office in 1o4 W °Pa Ivn Vr', cl ri'c44 �(� � P.. 3303®4 and principal office <br /> in I 0023 Saxiv rta.SS 'Pr IM, Q.>i 4e—t Z.% `:? .l e arcs_ B,eact/3. Ft. sZ wet. <br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. Ig — Cr..4 <br /> described as '4SO1-S4-eAr iS ( kQi 4WD r -- . 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 <br /> named entity has no financial interest in other entities submitting Bids for the same project. <br /> 4111 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 9 tify the City of Sunny Isles Beach. <br /> Dated this/ r day of , 2012 <br /> this <br /> 0.1)4 <br /> CI aIx e�1-e &Joni n 1 i ?rts <br /> FFIANT ^� Print or Type Name and Title <br /> worn to and subscribed before me this71/2d day of A_A �,/ ,20/e)! <br /> Personally Known,OR / <br /> 0 Produced Identification-Typ of Identification /; t /Z_ .' ,'Li- Z rt g®r/`ro <br /> NOTARY PUBLIC STATE OF FLORIDA e'`"'% 14ASHATH MORALES <br /> MY COMMISSION#FF977061 <br /> %°�5E}0'IRES:Merck 30,2020 <br /> 5of10 <br />