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Public Entity Crimes PUBLIC ENTITY CRIMES /. City of Sunny Isles Beach ,a;o cmrc avenue DJW °... tN+Mpnp:.;30.", 9a?�p6 fdc i]as i 9r931,) SWORN STATEMENT PURSUANT TO SECTION 287.133(3xa) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid of a Contract with a public entity for the construction of repair of a public building or public Work. may not submit Bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, SNrContractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287 017, FS for thirty six months from the date of being placed on the convicted vendor list ' . THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This swan statement is submitted Coe AWL F1.N whose business address s: l7 7 � O /VF /63 r dl 5'fvee #>t23 ag-e A kL -&-U,62- and (if applicable) its Federal Employer Iderdhfication number (FEIN) is (V the entity had no FEIN, include the Social Security Number of the in lividual signing this swom statement: _ ) 11.2. I understand that a "public entity, crime' as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation Of any state of federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, mckdirg, 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, Vneft, bribery, collusion, racketeering, conspiracy. or material misrepresentation. 11.3. 1 understand that'convided' or 'conviction' as defined in Para. 287.133(1Kb), Florida Statutes, means a fading of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal a state trail court of record relating to charges brought by indictment or information after Jury 1. 1989, as a result of a jury verdict. non -jury trial, or entry of a plea of guilty or nob contendere. 11.1. 1 understand that an "affiliate' as defined in Para. 287.133(1 Ka), Florida Stables, 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 tens 'affiliate" inckides 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 poring of equipment or income among persons when not for fair 2d 7 25