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`osNY iS44. <br /> CONFLICT OF INTEREST <br /> s <br /> .cs-,n City of Sunny Isles Beach <br /> 1' -;1 ? 18070 Collins Avenue <br /> • c-'} ' er Sunny Isles each,FL 33160 <br /> �, •.99 L'+pTelephone:(305)947-0606 Fax:(305)949-3113 <br /> yf ?'F 0%\ 4:' <br /> `'T*of 5uN �'4V 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 /> CO U N TY OF I(VU OM% DOI� l�aC.r►l <br /> BEFORE ME,the undersigned authority, personally appeared 1OW\? l d� Qe.nr n t , <br /> who was duly sworn,deposes,and states: -�� <br /> 1. I am the PYCSilitn•�" of DISQS-kr ?Co rcM Orta-}t4'1S? v�iith a local <br /> office in 904 W Tte Im yr, fterid 4 e 41 + F 1. Y303.4 and principal office <br /> in 10033 5'Ei,alra.cS 'Pr W, Qvi4e 12% ar4.JJe r Becuc47. Ft. 32° L . <br /> 2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. Ig - (xi-0 <br /> described as 'DQS0.54-tiv- 'eJor's (A41.-4-cti 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 /> 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 immediately7g tify the City of Sunny Isles Beach. <br /> Dated this / r day of �I ,204 <br /> ,041T • abr�el(? e+n► n rt50, - <br /> FFIANT Print or Type Name and Title <br /> worn to and subscribed before me this day of <br /> k 4 i�/ �,/ ,20/41'1' <br /> Personally Known,OR / <br /> 0 Produced Identification-Typ: of Identification d/-. ‘/Z... 8v"Z4"24;n6 2? yo <br /> NOTARY PUBLIC STATE OF FLORIDA�C . I • "'<e . : . : H MORALES <br /> MY co I IL ••# : -,•• <br /> EXPIRE :March 30,2020 <br /> 5of10 °` <br />