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PUBLIC ENTIT Y^RI M E SCity of Sunny Isles Beach18070 Collins AvenueSunny Isles Beach, FL 33160'''Y~^77^> '•"' Telephone: (305) 947-0606 Fax: (305) 949-3113SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)FLORIDA STATUTES, ON PUBLIC ENTITY CRIMESPUBLIC ENTITY CRIMESPursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliatewho has been placed on the convicted vendor list following a conviction for a public entity crime may not submit aBid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with apublic entity for the construction or repair of a public building or public Work, may not submit Bids on leases ofreal property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub-Contractor, orConsultant under a Contract with any public entity, and may not transact business with any public entity in excessof the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed onthe convicted vendor list".THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHEROFFICIAL AUTHORIZED TO ADMINISTER OATHS.11.1. This sworn statement is submitted to City of Sunny Isles Beachby Edward A. Dion[print incfivicjual's name ana tittejfor Nabors. Giblin & Nickerson. P.A.innt name of entity suDmitting sworn statementjwhose business address is:110 East Broward Boulevard, Suite 1700Fort Lauderdale, Florida 33301and (if applicable) its Federal Employer Identification number (FEIN) is 59-2427540(If the entity had no FEIN, include the Social Security Number of the individual signing this swornstatement:_.)11.2. I understand that a "public entity crime" as defined in Paragraph 287.133(1 )(g), Florida Statutes, means aviolation of any state or federal law by a person with respect to and directly related to the transaction ofbusiness with any public entity or with an agency or political subdivision of any other state or with theUnited States, including, but not limited to, any Bid or Contract for goods or services to be provided to anypublic entity or an agency or political subdivision of any other state of the United States and involvingantitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.11.3. I understand that "convicted" or "conviction" as defined in Para. 287.133(1 )(b), Florida Statutes, means afinding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in anyfederal or state trail court of record relating to charges brought by indictment or information after July 1,1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contenders.11.4. I understand that an "affiliate" as defined in Para. 287.133(1 )(a), Florida Statutes, means:a.) predecessor or successor of a person convicted of a public entity crime; orb.) Any entity under the control of any natural person who is active in the management of the entityand who has been convicted of a public entity crime. The term "affiliate" includes those officers,directors, executors, partners, shareholders, employees, members, and agents who are active inthe management of an affiliate. The ownership by one person of shares constituting a controllinginterest in another person, or a pooling of equipment or income among persons when not for fairDECEMBER 28,2010