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<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 />1) This sworn statement is submitted <br />to CITY OF SUNNY ISLES BEACH <br />by A Y A SOLUTIONS, INC <br />for DESIGN AND CONSTRUCTION OF FABRIC CANOPY STRUCTURE AT <br />GOVERNMENT CENTER <br />whose business address is <br />3001 W HALLANDALE BEACH BLVD SUITE 300 PEMBROKE PARK, FL 33009 <br /> <br />And(if applicable)its Federal Employer Identification Number (FEIN) <br />20-3767148 <br />(If the entity had no FEIN, include the Social Security Number of the individual signing this <br />sworn statement: <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 of federal law 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 other <br />state or of the United States, including, but not limited to, any bid or contact for goods or services to <br />be provides to any public entity or an agency or political subdivision of any other state or of the <br />United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or <br />material misrepresentation. <br /> <br />3) I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1) (b), Florida Statutes <br />means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of <br />guilt, in any federal or state trial court of record relating to charges brought by indictment or <br />information after July I, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or <br />nolo contenders. <br /> <br />4) I understand that an "affiliate" as defined in Paragraph 287. 133(1)(a),Florida Statutes, Means: <br />a) A predecessor or successor of a person convicted of a public entity crime; or <br />b) 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 come. 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 <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 />