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I
<br /> 11 Appendix III — Proposal Forms (continued)
<br /> I Crq,.....,
<br /> PUBLIC ENTITY CRIMES
<br /> City of Sunny Isles Beach
<br /> 15076 Cotti Avenue
<br /> 3
<br /> 160
<br /> a.u Sunny BFL 2ielepntne:(305)4.i7tO€Far( 0t)
<br /> 4:43113
<br /> e SWORN STATEMENT PURSUANT TO SECTION 287.133(3Xa)
<br /> FLORIDA STATUTES,ON PUBLIC ENTITY CRIMES
<br /> PUBLIC ENTITY CRIMES
<br /> I Pursuant to the provisions of paragraph (2)(a)of Section 287.133, Florida State Statutes-"A person or affiliate
<br /> who has been placed 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 threshdd amount Category Two of Sec.287.017, FS for thirty sbc months from the date of being placed on
<br /> the convicted vendor list".
<br /> I 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 Ides Beach
<br /> I by Pablo Llerena,Partner
<br /> IHNI Cnu i3ua,5 Rape a..-tam!
<br /> for GLSC&Company,PLIC
<br /> Ipma tame of a Nay su:ea::g swum sz:emeral
<br /> I whose business address is:
<br /> 6303 Blue lagoon Drive,Ste 200,Miami,FL 33126
<br /> 1 and(if applicable)its Federal Employer Identification number(FEIN)is 20-3157326
<br /> (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
<br /> statement: Not Applicable )
<br /> I 11.2. I understand that a"public entity crime"as defined in Paragraph 287.133(1)(g), Florida Statutes,means a
<br /> vidation 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 /> I public entity or an agency or political subdivision of any other state of the United States and involving
<br /> antitrust,fraud,theft,bribery,cdlusion,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 /> I 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 ndo contendere.
<br /> I
<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 /> I 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 contrdling
<br /> interest in another person.or a pooling of equipment or income among persons when not for fair
<br /> D_ae.ze?8.7010 2 o1 7
<br /> I
<br /> 1 PROPOSAL
<br /> I GLSC&COMPANY, PLLC RFP # 15-12-01
<br /> tom: reijiet peblir ar�"umm�n
<br />
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