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<br />RFQ 10-04-02 Professional Architectural Services
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<br />Sworn Statement
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<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY
<br />PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
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<br />1. This swom statement is submitted to City of Sunny Isles Beach
<br />by Thomas M. Carlson, AlA, LEED AP, Principal
<br />for M.C. Harry & Associates, Inc.
<br />whose business address is 2780 S.W. Douglas Road, Suite 302, Miami, Florida 33133
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<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 59-2281430
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<br />(IF the entity had no FEIN, include the Social Sectuity Ntunber of the individual signing this
<br />swom statement:
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<br />2. 1 lUlderstand that a "public entity crime" as defUled in Paragraph 287. 133 (1)(g), Florida
<br />Stattltes, means a violation of any state or federal law by a person with respect to and directly
<br />related to the transaction of business with any public entity or with an agency or political
<br />subdivision of any other state or of the United States, including, but not linlited to, any bid or
<br />contract for goods or selvices to be provided to any public entity or an agency or political
<br />subdivision of any other state or of the United States and involving antitmst, fraud, theft,
<br />blibery, collusion, racketeering, conspiracy, or material misrepresentation.
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<br />3. 1 lUlderstand that "convicted" or "conviction" as defmed in Paragraph 287. 133 (l)(b), Florida
<br />Statutes 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 tIial cotui of record relating to charges brought by
<br />indictment or infOlmation after July 1, 1989, as a result of a jmy verdict, nonjmy tI'ial, or
<br />entry of a plea of guilty or nolo contenders.
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<br />4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), FIOlida Statutes, means:
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<br />a. A predecessor or successor of a person convicted of a public entity Clime; or
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<br />b. An entity Imder the contI"ol of any natural person who is active in the management of the
<br />entity and who has been convicted of a public entity come. The telID "affiliate" includes
<br />those officers, directors, executives, partners, shareholders, employees, members, and
<br />agents who are active in the management of an affiliate. The ownership by one person of
<br />shares constituting a controlling interest in another person, or a pooling of equipment or
<br />income among persons when not for fair market value under an ann's length agreement,
<br />shall be a prima facie case that one person controls another person. A person who
<br />knowingly enters into a joint ventme with a person who has been convicted of a public
<br />entity crime in Florida during the preceding 36 months shall be considered an affiliate.
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<br />5. I lUlderstand that a "person" as defined in Paragraph 287 . 1 33(1)(e ), FIOlida Statutes, means
<br />any natmal person or entity organized under the laws of any state or of the United States
<br />with the legal power to enter into a binding contract and which bids or applies to bid on
<br />contI'acts for the provision of goods or services let by a public entity, or which otherwise
<br />transacts or applies to transact business with a public entity. The tetID "person" includes
<br />those officers, directors, executives, partners, shareholders, employees, members, and
<br />agents who are active in management of any entity.
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