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21 z FUBLIC ENTITY CRIMES City of sunny Isles Beach r iaert0 rA*m nvenas 'F.�'': ►tui •` Sumry Isley Beach FL so= tu" ►� Telephone (305) 1 Far rwal wn-a i is SWORN STATEMEn i PURSUANT TO SEL-t1un 287.133(3)(a) FEuKl—VA STATUTES, ON PUBI1c EmTm t fumes PUBLIC ENTITY CRIMES Pursuant to the provisions of paragg, aph (2) (a) of section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list followil Ig a conviction for a public entity crime may nut submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid ona Contract with a public entity fvr the construction or repair of a public building or public Work; may not submit Bids on leases of rear proparty to a public entity, may not be awar3ed to perform Work as a Contractor, supplier, Sub -Contractor, 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 Sc.. 287.017: FS for thirty six months tram 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 uFrlirlAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to L: ry or sunny Isies eseac by Aida M. Curtis inm== a name am buel for "'r[i® + Kogere Design Studio, Inc. ip.1 nam 31 en swam emen whose business address is: iSzO S. Rea Road, S,..tz M Miami, Florida 33143 and (if applicable) its Federal Employer Ideldification nuu-iber (FEIN) is 65-Oe94753 (If the entity had no FEIN, include the Social Security Number of the indivioual signing this sworn statement: ) 11.2. 1 understand that a "public entity crime" as aefined in Paragraph 287A33(1)(g), Florida Statutes, means a violation of any state or IMarai law 6y a pcis-un 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, including, 6ut not limited to, any Bid or Contract for goods or services m 6a provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, then, 5"Ibery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 28r.133(1)(b), e-lorida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjuaaicatio" of guilt, in any federal or state trail wart of record relating to charges brought by indictment or information after Jury 1; 1989, as a result of a jury verd".t, nun -jury trial, or enh y or a plea of guilty or nuly contendere. 11.4- 1 understand that an "affiliate" as defined in Para. 287.133(1 Ka): Florida Statutes, means: a.) preaawssor or suLA emwur or a person convicted of a public entity crime; or b.) Any entity under the control of any naturae person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes tnuae officers, directors, executors, partners, shareholders, employees, members, and agents who aye active in the managcni unt of an affiliate. I he ownership by one person of shares constituting a conu-olling interest in another person, or a pooling of equipment or incomamong persons when not for fair Ds m -z29,20,0 2or7