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<br />AUG-Z3-0 I 1 Z : 04PM FROM-C I TY OF SUNNY I SLES BEACH
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<br />+3059493113
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<br />7-100 p 09/10 F-713
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<br />SWORN STATEMENT PUHSlJANT TO SECTION 287.]~J(J)(a)
<br />FLORIDA ST A TUTES..ON PUBLIC ENTITY CIUl\lES
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<br />TIllS FOR..\1 MUST BE SIGNED Mm SWOR~-l TO IN THE PRESENCE OF A NOTARY Pl1BUC OR
<br />OTHER OFFICIAL AlITHORlZED TO ADMINISTER OATHS.
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<br />1. This swam stareme-m is submined to City of Sunny Isles Beach
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<br />by Shenandoah General Construction Company
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<br />fur Storm Drain Cleaning & Jetting of Lines (RFP No. 01-08-01)
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<br />whose business address is
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<br />1888 NW 22 Street
<br />Pompano Beach, FL 33069
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<br />954-975-0098
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<br />and (if applicable) its Federal Employer Idenufkation Nwnber (FEIN) IS 59-1707673
<br />(IF the entity had no FEf.'l, mclude the SOCial Secunty Number of the indIvidual signing this swom
<br />statement:
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<br />2. I understand that a "public entity crime" as defined in Paragraph 287. 133(l}(g), Florida Starurcs, m~ans a
<br />violation of any stare or federal law by a per~on with respecr to and directly rt'lared to the transaction of
<br />business with any public entity or with an agency Or political subdivision of any other state or of the
<br />United States, including, but not limited ro, any bid or contract for goods or services ro be provided to any
<br />public entity or an agency or political subdivi ,ion of any other state or of the: United States and involving
<br />antitrust, fraud. theft, bribery, collUSIOn, racketeering, conspiracy, or material misrepresentation,
<br />
<br />3. I understand that "convicled" Or "conviction" as defined in Paragraph 287.1330)(b), Florida Sr.aIUles
<br />means a finding of gwlt or a convi,tion of a public entity crime, with or without an adjudication of guilt, in
<br />any federal or stare trial coun of record relatmg to charges brought by indicnnent or information after July
<br />1. 1989, as a result of a jury verdict, nonjury nial, or entry of a plea of guilty or nolo conrenders.
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<br />4. I understand that an "affiliate" as defmed in Paragraph 287. 133(1)(a), Florida SlanJleS, means:
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<br />1 ^ pr~decessor Or successor of a pcrson cl'nvicred of a public entity crime; or
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<br />2, An entity under the connol of any nalwA person who is active in the management of the entity and
<br />who has been convicted of a public tlnity come. The term "affiliate" includes those officers.
<br />directors, executives, panners, shareholders, employees, members, and agents who are active in the
<br />management of an affiliate. The ownership by one person of shares constituting a controlling interest
<br />in another person, or a pooling of equipment or Income among persons when not for fair market value
<br />Wlda an arm's length IIgJttmc:nt, shall be a prima facie: case that one person controls another person
<br />A person who knowingly enters into a JOint venture with a person who has been convicted of a pubhc
<br />ennty crime in Florida dunng the preceding 36 months shall be considered an affiliatt.
<br />5. 1 understand that a ')>erson" as defmed in Paragraph 287.IJ3(1}(e), Florida Statutes, means any natural
<br />person or entity organized under the laws of any Stare or of the United States WIth the legal power to enter
<br />into a binding contract and which bids Or applies to bid on Contracts for the provision of goods or services
<br />ler by a public ennty, or which otherwise transacts or applies to transact business wi~ a public entity. The
<br />term "person" includes those officers, directors, executives, parmers, shareholders, employees, members,
<br />~rTho are arrive m manag=en' of..y en,;ry.
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<br />
<br />f'LtN
<br />Daniel Dh1ura
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<br />Signature
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<br />August 30, 2001
<br />Date
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<br />RFPOI-08-01 SIO,"," Drat" CleMi,.,. cI Jelrl"g OfLi~
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<br />Page 7 of 7
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<br />8/14/01 10,HAM
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