|
4�ptHr rsOA
<br />PUBLIC ENi,i,ry CRIMES
<br />City of Sunny tsles Beach
<br />10070 Collins Avenue
<br />'r'i CpF, • G lOR5o4 �� $Unnr Isles B4a�L Fk. 33tG4
<br />Tulcphbn'S_ (305) 947-0606 Fax: (305) 959-31.13
<br />SWORN STATEMENT PURSUANT TO SECTION 207.133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTrrY CRIMES
<br />PUBLIC ENTITY CRIMES
<br />Pursuant to the provisions of paragraph (2) fat of Section 287.133, Florida State Statutes -"A persorl or atftiate
<br />who has been placed on the convicted vendor list following a conviction for .a public entitycri'rrie may not submit
<br />Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Con:tractwith a
<br />public -entity for the construction or repair of a public building or public Work, may net submit Bids on, fusses of
<br />real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub -Contractor, or
<br />Consultant udder 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, F5 for thirty six months from the date of being placed on
<br />the convicted vendor list".
<br />THIS FORM MUST BE SiGWED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFtCIAL AUTHORIZE] TO ADMINISTER OATHS.
<br />1. This swam statement is submitted to Gity of Sunny Isles Beach.
<br />Dfirl WelM'7Ual's name and li[lej
<br />for I sct."fir F Cam` rA4 - crs � Tod._
<br />[,1rinl fianx tff .idly sek-niltin j %wU OalamanQ
<br />whose business address is:
<br />and (if applicable) its Federal Employer identification number (FEIN) is
<br />(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
<br />statement:
<br />2.. 1-understand that a "Public entity crime" as defined in Paragraph 287,133(1){9j, 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 goads 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 />3, 1 understand That "convicted" or"c0nvictibn" as defined in Para,. 287.133(1)(b), Florida Statutes,, means a
<br />(hiding of guilt or. a conviction of a public entity crime, with or without an adjud:i ties 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 4f a plea of guilty or polo contenders,
<br />4. I understand that an "affiliate" as defined in Para. 287.133(1)(a), Ronda 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 rnanagement of the entity
<br />and wtla has been convicted of a public entity crime, The term "affiliate" includes those officem,
<br />director's, exdcutors, partners, shareholders, employees; members, and agents who are active in
<br />the management of an affiliate, The ownership by one person of stares constituting a controlling
<br />Interest in another person, or a pooling of equipment or income among persons when not for fair
<br />)-of 10
<br />
|