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Craig A. Smith
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(18-11-01) Consult. Engin. Svs. for Golden Shores Pump Station Rehabilitation (CCNA)
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Craig A. Smith
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Last modified
12/11/2018 3:27:16 PM
Creation date
12/11/2018 3:03:53 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Golden Shores Pump Station CCNA
Bid No. (xx-xx-xx)
18-11-01
Project Type (Bid, RFP, RFQ)
RFQ
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o`S�NNY �SlFreir <br />CONFLICT OF INTEREST <br />c Z <br />City of Sunny Isles Beach <br />• 18070 Collins Avenue <br />y''•r�os`oa �` Sunny Islas Beach, FL 33160 <br />Telephone: (305) 947-0606 Fax: (305) 949-3113 <br />CONFLICT OF INTEREST STATEMENT <br />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 />City of Sunny Isles Beach or its agencies. <br />STATE OF FLORIDA <br />COUNTY OF Palm Beach <br />BEFORE ME, the undersigned authority, personally appeared Stephen C. Smith who was duly sworn, <br />deposes, and states: <br />18.1. 1 am the Senior Vice President of <br />Craig A. Smith & Associates, Inc. with a local office in Boca Raton. Florida and principal office in <br />Boca Raton, Florida <br />18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No.RFQ No. 18-11-01 described <br />as: Consulting Engineering Services for Golden Shores Pump Station Rehabilitation (CCNA). The Affiant has made <br />diligent inquiry and provides the information contained in this 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 />18A Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in <br />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 />18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any <br />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 />18.81 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 Sunny Isles Beach. <br />Dat his 10t day of December , 2018. <br />�� Stephen C. Smith, P.E.. Senior Vice President <br />AFFIA - Print or Type Name and Title <br />Sworn to an ub c ed before me this 10th day of December 2018. <br />81 Personally own OR <br />O Produced Identification ; Type of40entfication <br />I L <br />NOTARY PUBLIC STATE OF FLORIDA <br />Amanda J. Denton <br />tele d FbrideRNE] <br />entonn GG 0678392021 <br />DECE.eER28,2010 <br />191 <br />
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