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' FROM AYLWARD FAX NO. : 9544245852 Feb. 07 2003 09:29AM P9
<br />PEB-00-33 01:00M FROM -CITY OF SUNNY ISLES BEACH 0303901111 T -091 0.09/10 F -339
<br />SWORN STATEMENT PURSUANT TO SEMON 287,133(3)(a)
<br />FLORIDA STAT17IT ON PUBLIC ENTITY C LMeS
<br />THIS F017LM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A ?VOTARY PUBLIC OR OTHER
<br />' OMaAL AIJTHOPJZM TO ADMINISTM OATHS.
<br />I. Tbis sworn soatemst is submitted to -C1,-� of
<br />by �,Ca C�
<br />' for -
<br />,Whose business address is a' I cIl
<br />2-9) -
<br />' and (if applicable) its Federal Employer Idetttlticadon Number (FEIN) is �— ' 7 7
<br />(IF rile entity had no PEIN, inclu4e the Social Smwity Nwttber of tthe individual 'taping this sworn statement:
<br />' 2. 1 unknu and that a 'public en tity crirrn" as defined in Paragraph 287.133(t)(g), Florg Saul.. means a violation of
<br />my state or federal law by a person wide respect to and directly related to the transaction of business with any public
<br />entity or wi dt, an agency or political subdivision of any other suta, or of the United States, ineludiag, but not limited to,
<br />any bid or contract for goods or satvicas to be provided to spy public eatiry or an tgea y or political subdivision of any
<br />' other state or of the United States and involving antitrust. fraud. theft, bribery, collutiom racla�wering, coaxpiracy, or
<br />mvzrw miffepr cantatiod.
<br />3. 1 understand that " convicted" or "conviction" as defined in ftrograph 287.133(1 ) (b), F means a ending
<br />of guilt or a cmviction of a public entity crime, with or %fd►out au.adj:,dieation of wilt, m any federal or atue trial
<br />' court of record relating to charges brought by ia&ctmGnt er inforraouan after Iu1y 1, 1989, SS J insult of a;ury verdict,
<br />nOmjttty trial. or entry of a plea of guilty or polo conten&ns.
<br />4. 1 understand *at an "aflilisse" tit defined so Paragraph 287.133(1}(x), jg tide Statures- rneans:
<br />a_ A predecessor or successor of a person convicted of a public enrity crime; or
<br />b. An entity under rho eoMnl of any annual person svbo is active i!a tlut tnsnagcmrai of the eati.y and wbL' hie o=
<br />eanvkwd of a public entity come. The term "af Bate" inc16cs those ofiicen. dirtc -=s, cnecunvcs, pwners,
<br />shareholders, employees. members, and agents who are actitc ,a the trsmaStment of an 3ftilate. 'The ownership
<br />' by one person of &ham constituting a controlling inurest in anodrer person, or a .pooling of e4uiprnent or iaconre
<br />==g person¢ when not for fair market value under an arm'; length agreement, A-11 be a prima facie ace that
<br />one person controls anerbef person. A person who knowingly eaters imo a,osin venture aith a person who bns
<br />been convicted of a public entity crime in Florida. during the pfteeging 36 r,mstlm shall be considered an nffiliatc .
<br />1 understand than a'-person" as defined in Paragraph 297.133(1)(e), Florida Mutes, means any natural person or entity
<br />organized under the laws of any state or of the United States with the legal power to entry into a binding contract and
<br />which bids er applies to bid ea contracts for the provition of goods of se vutes Iot by a public entity, of which
<br />odso w a transacts or applies to transact business witE a public entity. T he terra "person" includes these o £peers,
<br />dhwmrs, executives, paimers, shareholders, etnployeea, it sad a5enrs who are a..tive in managcr_ictit Of any
<br />SIGNATURE GF AFFffin- (Priturd or Typed UpI game i,rnftlant)
<br />' suwof�Llc �- Coa�yof ��C Fr—t) Swum co tuna subscri ,l befere to this day of 'L /A> ' � � 20(4 by
<br />Notary Seal.
<br />Noury's Narrc Prinr-d, Stamped or Typed
<br />' �►Q'q4 Evelyn A Martin
<br />personally lnown, or Produced Identification 7k ( *My Comrrussion CC882530
<br />F �+�'Fs,,Fw/l/ Expires August 12, 2003
<br />Nerd. :cation Produced
<br />
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