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11
<br /> ® E ly ,si
<br /> PUBLIC ENTITY CRIMES
<br /> ® ,•.'. ._ City of Sunny Isles Beach
<br /> I7e7 teRm s teenue
<br /> 4)
<br /> Sunny Isles Se3Cn,FL 33160
<br /> Telepnone 1305)94F-0 605 Fu(30f.)9493113
<br /> ® SWORN STATEMENT PURSUANT TO SECTION 287.133(3Xa)
<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 /> epublic 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 /> �(I 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 /> e OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br /> 11.1. This sworn statement is submitted to City of Sunny Isles Beach
<br /> ® by Manuel Svnalovski Managing Principal
<br /> j5Ii, man mums name aoa m ci
<br /> ® for Manuel Sv'nalovsk' ssnc'atea . LL('
<br /> tocol vane of Pally sormaang sworn s�ernenll
<br /> whose business address is:
<br /> 1800 Slier Drive, Suite 500
<br /> O Fort Lauderdale, Florida, 33316
<br /> and(if applicable)its Federal Employer Identification number(FEIN)is 27-04 414 3 3
<br /> (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
<br /> statement: .)
<br /> ® 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 /> 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 atter 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 /> ((1 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 /> (lj DtcnwomLI,2910 2 ot
<br /> ®$ RFQ # 12-04-02 53 �J i
<br /> ArIA
<br /> .w,MJEL SY.NALOVSKI ASSOCIATES,LLC
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