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c SUNNr ;c fr 4 _ 1 PUBLIC LNTI'I'Y LIZIMf?S City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947-0808 Fax: (305) 949-3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "q who has been placed on the convicted vendor list following a conviction for a public entity crime may it a Bid on a Contract to provide an person or affiliate y goods or services to a public entity, may not submit Bid on a Contract with a Public entity for the construction or repair of a public building or public Work, may not submit Bids on le real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub -Contractor Consultant under a Contract with an leases of of the threshold amount Category Two of public 287.01d7 FS fomay ortth thirty six montransact ths from the date or the convicted vendor list". Y public entity in excess of being placed on THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OT OFFICIAL AUTHORIZED TO ADMINISTER OATHS. HER 11.1. This sworn statement is submitted to Cit of Sunn Isles Beach by Mark Bryan 411M, Project Manager jpnnt individual's name and title] for NnPlvin whose business address is: 14215 sw 156 terrace Miami, F133177 and (if applicable) its Federal Employer Identification number (FEIN) is 81-2999584 (If the entity had no FEIN, include the Social Security Number of -1he individual signing this sworn statement: ) 11.2. I understand that a "public entity crime" as defined in Paragraph 287.133(i), violation of any state or federal law by a person with respect to and dir ctly related to the trans ct on of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal 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 contendere. 11.4. 1 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; or b.) Any entity under the control of any natural person who is active in the management of the entity and 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 in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBER 2B, 2010