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(07-10-02) Central Island Drainage
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Man-Con, Inc.
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Last modified
7/16/2010 4:23:46 PM
Creation date
8/13/2008 2:28:02 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Central Island Drainage and Street Improvements
Bid No. (xx-xx-xx)
07-10-02
Project Type (Bid, RFP, RFQ)
Bid
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<br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />~ <br />~ <br />~ <br />~ <br /> <br />. <br />.. <br /> <br />i <br />.. <br /> <br />~ <br /> <br />! <br />~ <br />~ <br />~ <br /> <br />3 <br /> <br />. <br /> <br />. <br />... <br /> <br />. <br />~ <br /> <br />Ii <br />.- <br /> <br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), <br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br /> <br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC <br />OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. <br /> <br />I. This sworn statement is submitted to The City of Sunny Isles Beach, Florida <br /> <br />by <br /> <br />Guy A. Mancini PresIdent <br />[print individual's name and title] <br />Man-Con, Incorporated <br />[print name of entity submitting sworn statement] <br /> <br />for <br /> <br />whose business address is <br /> <br />MAN CON, INC. <br />3460 S.W. lITH STREET <br />DEfRFIELD BE;ACH. Fl 33442 <br />(954) 427-0230 PH. (954) 427-8133 FAX <br /> <br />and (if applicable) its Federal Employer Identification Number (FEIN) is 59 - 2.S....' 7 'i 2>.L <br /> <br />(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn <br />statement: <br /> <br />. ) <br /> <br />2. I understand that a "public entity crime" as defined in Paragraph 287.133(1 )(g), Florida Statutes. <br />means a violation of any state or [ederallaw by a person with respect to and directly related to the <br />transaction of business with any public entity or with an agency or political subdivision of any <br />other state or of the United States, including, but not limited to, any bid or contract for goods or <br />services to be provided to any public entity or an agency or political subdivision of any other state <br />or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering. <br />conspiracy, or material misrepresentation. <br /> <br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1) (b), Florida <br />Statues, means a finding of guilt or a conviction of a public entity crime, with or without an <br />adjudication of guilt, in any federal or state trial court of record relating to charges brought by <br />indictment or information after July I, 1989, as a result of a jury verdict. nonjury trial, or entry of a <br />plea of guilty or nolo contendere. <br /> <br />4. <br /> <br />I understand that an "affiliate" as defined in Paragraph 287.133(1) (a), Florida Statutes. means: <br /> <br />I. A predecessor or successor of a person convicted of a public entity crime; or <br /> <br />2. An 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, executives, 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 />market value under an arm's length agreement, shall be a prima facie case that one person controls <br />another person. A person who knowingly enters into a joint venture with a person who has been <br />convicted of a public entity crime in Florida during the preceding 36 months shall be considered <br />an affiliate. <br /> <br />5. <br /> <br />. I understand that a "person" as defined in Paragraph 287.133(\) (e), Florida Statutes, means any <br />natural person or entity organized under the laws of any state or of the United States with the legal <br />power to enter into a binding contract and which bids or applies to bid on contracts for the <br />provision of goods or services let by a public entity. or which otherwise transacts or applies to <br /> <br />Oct. 2007 <br />Form PUR 7068 (Re\'. 06/11/92) <br /> <br />00402-1 <br />
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