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� I <br />CITY OF SUNNY ISLES BEACH <br />PARKS /MEDIANS/RIGHT -OF -WAY MAINTENANCE <br />sworn statement on the convicted vendor list. (Attach a copy of the final order.) <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS FOR <br />THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER <br />31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM <br />REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT <br />IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA <br />STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION <br />CONTA D2nT US FORS <br />L,6z Ez?,o <br />(Printed Name} <br />(Title) <br />Sworn to and subscribed before me this day of 06 AV 0 <br />Personally known o rn & _ <br />fy Or Produced Identifi a on �L .� �- Notary Public - State of <br />My Commission Expires / ° /a a° 11 3 (Type of <br />ioAf <br />(Pr" Oe�tt commissioned <br />na - �r�T,j '�" <br />� � we � '�Wnd�{�ngCo., Inc. <br />BIDDERS NAME: LtF <br />COMPANY NAME: 5 �� <br />