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<br />
<br />entity. The term "person" jncludes those offjcers, directors, executjves, partners, shareholders,
<br />employees, members, and agents who are active in management of any entity.
<br />
<br />6. Based on information and beljef, the statement which I have marked below is true in a relation to
<br />the entjty submitting thjs sworn statement. (Please jndicate whjch one (1) of the following three (3)
<br />statements js applicable.)
<br />
<br />X.J1) Nejther the entjty submjttjng this sworn statement, nor any of its officers, directors, executjves,
<br />partners, shareholders, employees, members, or agents who are actjve jn the management of the entity, or
<br />any affiljate of the entjty has been charged wjth and convjcted of a public entjty crjme wjthjn the past 36
<br />months.
<br />_(2) The entjty submitting this sworn statement, or one or more of jts offjcers, djrectors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of the entity, or
<br />any affiliate of the entjty has been charged with and convicted of a public entity crime wjthjn the past 36
<br />months.
<br />_(3) The entjty submjtting thjs sworn statement, or one or more of its officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are actjve jn the management of the entity, or
<br />agents who are active jn management of the entity, or any affiliate of the entity has been charged wjth and
<br />convicted of a public entity crjme withjn the past 36 months. However, there has been a subsequent
<br />proceeding before a Hearjng Offjcers of the State of Florida, Divjsion of Administratjve Hearjngs and the
<br />Final Order by the Hearing Offjcer determined that it was not jn the public jnterest to place the entjty
<br />submitting this sworn statement on the convicted vendor list. (Attached is a copy of the final order.)
<br />
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY
<br />AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT
<br />IS FILED AND FOR THE PERIOD OF THE CONTRACT ENTERED INTO , WHICHEVER PERIOD IS
<br />LONGER. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO
<br />ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION
<br />287.017, FLORIDA STATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE INFORMATION
<br />C NTAIN D IN THIS FORM.
<br />
<br />
<br />Reinaldo Boraes, R.A., AlA. NCARB
<br />(Printed or Typed Legal Name of Affiant)
<br />
<br />State of Florida County of Miami-Dade
<br />
<br />
<br />\hiWJo l10rGvV\)
<br />
<br />Notary's Name Printed, Stamped or Typed
<br />
<br />Notary Seal:
<br />
<br />i~~~ -j\ Notary Public State of Florida
<br />. . Natalia Moreno
<br />'1 C ,..I My Commission 00756359
<br />.,.o,~ci"' Expires 02107/2012
<br />
<br />
<br />Personally Known: ~ or Produced Identification _
<br />
<br />10
<br />
<br />City of Sunny Isles Beach, Fl Professional General Architectural Services RFQ No. 10-04-02
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