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<br />11tJ13LIC ENTITY CRIMES
<br />City of Sunny isles Beach
<br />' L + I B070 Collins Aveaue
<br />4
<br />y��ry'FLOFi o`r S�nWcs Beach, FL 33160
<br />Tek?non! (3Q 647-060B Fax: 1906) 049-3113
<br />SWORN STATEMENT PURSUANT TO SlECTIOtN 287.%33(3)'(a)
<br />FLoRi A STATUTES, ON PUBLIC ENTITY CRIMES
<br />PUBLIC ENTITY CRIMES
<br />Pursuant to the provisions of paragraph (2} (a) of Section 287..133. Florida State Statulea - "A person or affiliate
<br />who has been placed on the convicted vendor list following a conviction fora public entity crime may not submit a
<br />Bid on a Contract to prbuide,any goods or services to a public entity, may not submit a Bid on a Contract with a
<br />public entity for the conslruction or repair of•a public building or. public U4rork, may not submif Bids an leases of
<br />real'properry In a public entity, may not be awarded to peifonn Work as a Contractor, supplier, Sub -Contractor, or
<br />Consultant under a Contract with any public entity, and may 4nt 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 />0Fri cIAI_ AUT"ORIZEC) TO ADMINISTER OATH5.
<br />1. This sworn statement is submitted to C ity of 6 u n rry Isles Beach
<br />t}y 3levrn Glenn. VIA-preflJenl
<br />jp I inrwouea rams and mlcj
<br />for T--dal Besu, Gmrn ncil Cwduhin. LLC
<br />[pSm n 2 at c6l.ily eubrnlirV sK1un sffi:emeall
<br />whose business address is.
<br />121 %,i,e ; ,ark prWe, UGo, NY 135n2
<br />and (if applicable) its Federal Employer Identification number (FEIN) iS.14-es26493
<br />(If the entity had no FEIN, include the Social Security Number of the individual signing lets sworn
<br />2- 1 understand that a "public entity crime" as defined in Paragraph 237.133(1)(g), Florida Statutes, means a
<br />violation of any stale or federal late 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 slate of the United States arid, involving
<br />antitrust, fraud, theft; bribery, collusion, racketeering, conspiracy, or material misrepresentation,
<br />3. I understand that "convicted" or "conviction" as defined in Para. 2.87-133{1)(4), Florida Statutes, means a
<br />finding of guilt or a conviction of a public -entity crime, with or without an a.ajudicalion of guilt, in- any
<br />federal or state trait court of record nl lating 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 contenders.
<br />4- 1 understand that an "affiliate" as defined in Para, 287.133(1){a), Florida Statutes, means,.
<br />a.) predecessor or successor of a person convicte(I of a public en lily crime; or
<br />b.) Any entity under the contioi 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 these officers,
<br />directars, executors, partners, shareholders, employees, members, and agents Who are'aclive in
<br />the management of an affiliate. The ownership by one person of shares constituting a•cantrol)ing
<br />interest in an6ther person, or a pooling of equipment or income among persons when not for fair
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