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" CITY OF SUNNY ISLES BEACH
<br /> I I SECTION SIX: CONTRACT FORMS
<br /> market value under an arm's length agreement, shall be a prime fade case that one person
<br /> controls another person. A person who knowingly enters into a joint venture with a person who
<br /> • has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br /> • considered an affiliate.
<br /> ® 11.5. I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
<br /> person or entity organized under the laws of any state or of the United States with the legal power to
<br /> • enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or
<br /> ® services let by a public entity, or which otherwise transacts or applies to transact business with a public
<br /> entity. The term "persons" includes those officers, directors, executives, partners, shareholders,
<br /> employees, members, and agents who are active in management of any entity.
<br /> $ 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity
<br /> ® submitting this sworn statement. (Indicate which statement applies.)
<br /> X Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners,
<br /> shareholders, employees, members, or agents who are active in the management of the entity, nor any
<br /> ® affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br /> 1989.
<br /> • The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> shareholders, employees, members, or agents who are active in the management of the entity, or an
<br /> ® affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br /> ® 1989.
<br /> The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> shareholders, employees, members, or agents who are active in the management of the entity, or an
<br /> ® affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br /> 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of
<br /> ® Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the
<br /> ® State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
<br /> determined that it was not in the public interest to place the entity submitting this sworn statement on the
<br /> ® convicted vendor list. (Attach a copy of the final order.)
<br /> • I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br /> ® PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE)ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br /> THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
<br /> ® ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br /> A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br /> ® STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> •
<br /> By 4/Ir v�'�C//
<br /> EIc
<br /> G(Sgnature)
<br /> ®
<br /> Mark Tomczyk.P.F.
<br /> ® (Printed Name)
<br /> Vice President
<br /> ® (Title) � /
<br /> • I S prn,to an subg;ibed before me this,-,pv day of ( ,2012 , by
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<br /> 11
<br /> mmeemnra�r u Sig pat(i otary/Pun a Sate of Florida
<br /> Print eir Type Commissioned Name
<br /> Personally Known L.Z. OR Produced Identification
<br /> • Type of Identification Produced
<br /> CS KEITH and SCHNARS,P.A.
<br /> ® � RFQ12-04-02 PAGE 53 F1ARIOAs&LOALRam
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