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<br /> ® at
<br /> PUBLIC ENTITY CRIMES
<br /> 3.
<br /> City of Sunny Isles Beach
<br /> ® _ 18070 Cofns Avenue
<br /> J,kir;
<br /> s
<br /> '
<br /> "'•,sow d Sunny Isles Beach.FL 33160
<br /> o - tr o,tun_ Telephone:(305)947-0606 Fax:(305)949-3113
<br /> e! SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br /> FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
<br /> ® PUBLIC ENTITY CRIMES
<br /> ® 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 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 /> OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
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<br /> 11.1. This sworn statement is submitted to City of Sunny Isles Beach
<br /> • by Peter Moore. P.E., LEED AP President
<br /> (print mdendual s name and udej
<br /> • for Chen Moore and Associates
<br /> tplmt name of envIy submtmng sworn statement)
<br /> ® whose business address is:
<br /> • 1444 Biscayne Boulevard,Suite 204 Miami, FL 33132
<br /> •
<br /> • and (if applicable)its Federal Employer Identification number(FEIN)is 59-2739866
<br /> O (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
<br /> • statement: .)
<br /> B 11.2. I understand that a "public entity crime"as defined in Paragraph 287.133(1)(g), 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 /> e 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 state of the United States and involving
<br /> ® antitrust, fraud, theft, bribery, collusion, 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 /> • 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 nolo contendere.
<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 /> 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 controlling
<br /> ® _ interest in another person, or a pooling of equipment or income among persons when not for fair
<br /> • ..CHENMOORE.
<br /> RE0No.12-04-02 Continuing Professional Architectural&Engineering Services Firms Only(CCNAJ
<br /> • .'i:nuocuifs' Category:Civil Engineering 7-6
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