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RFP No. 19-12-01 Printing and Mailing Services
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Colonial
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SUNNY�S�E <br /> PUBLIC ENTITY CRIMES <br /> max. : City of Sunny Isles Beach <br /> r 180070 Collins Avenue <br /> st 9,•F op' 4�� Sunny Isles Beach,FL 33160 <br /> >`:or.saµ'�c Telephone:(305)947-0606 Fax:(305)949-3113 <br /> SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) <br /> FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br /> PUBLIC ENTITY CRIMES <br /> to theprovisions ofparagrapha of Section 287.133, Florida State Statutes - "A person or affiliate <br /> Pursuant (2) O <br /> has placed been on the convicted vendor list following a conviction for a public entity crime may not submit a <br /> Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a <br /> public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of <br /> real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub-Contractor, or <br /> Consultant under a Contract with any public entity, and may not transact business with any public entity in excess <br /> of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on <br /> the convicted vendor list". <br /> THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER <br /> OFFICIAL AUTHORIZED TO ADMINISTER OATHS. <br /> 11.1. This sworn statement is submitted to City of Sunny Isles Beach <br /> by Chris Seruga Chief Operating Officer <br /> [pnnt individual's name and title] • <br /> for Colonial Press International, Inc. <br /> O [pnnt name of entity submitting sworn statement) <br /> whose business address is: <br /> 3690 NW 50th St. Miami, FL 33142 <br /> and (if applicable) its Federal Employer Identification number(FEIN) is 65-0066972 <br /> (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn <br /> statement: .) <br /> 11.2. I understand that a"public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a <br /> violation of any state or federal law by a person with respect to and directly related to the transaction of <br /> business with any public entity or with an agency or political subdivision of any other state or with the <br /> United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any <br /> public entity or an agency or political subdivision of any other state of the United States and involving <br /> antitrust,fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. <br /> 11.3. I understand that"convicted" or"conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a <br /> finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any <br /> federal or state trail court of record relating to charges brought by indictment or information after July 1, <br /> 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere. <br /> 11.4. I understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means: <br /> a.) predecessor or successor of a person convicted of a public entity crime; or <br /> b.) Any entity under the control of any natural person who is active in the management of the entity <br /> and who has been convicted of a public entity crime. The term "affiliate" includes those officers, <br /> directors, executors, partners, shareholders, employees, members, and agents who are active in <br /> the management of an affiliate. The ownership by one person of shares constituting a controlling <br /> interest in another person, or a pooling of equipment or income among persons when not for fair <br /> DECEMBER 28,2010 <br />
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