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APR -03 -2006 12:58PM FROM -CITY OF SUNNY ISLES BEACH $057921563 T -430 P.001 /001 F -425
<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(x)
<br />FLORIDA, STATUTES, ON PUBLIC ENTITY CRIMES
<br />TI-115 FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL
<br />AUTHORIZED TO ADMINISTER OATHS. I l�
<br />1. This sworn statement is submitted to 1� y ��U 1,. 11` V � Ies L&A.I.L
<br />by �!' V
<br />for
<br />whose bu Psl`� address is
<br />(A. IM,,
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is_
<br />(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement:
<br />2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(I)(g), Tlorida Statute„ means a violation of any
<br />state or federal law by a person with respect to and directly related to the transaction of business with any public entity or
<br />with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or
<br />Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of
<br />the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material
<br />misrepresentation.
<br />3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287,133(l)(b), florid a Statutes means a finding of
<br />guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of
<br />record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial,
<br />or entry of a plea of guilty or nolo contenders.
<br />4, 1 understand that an "affiliate" as defined in Paragraph 287.133(l)(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 and who has been
<br />convicted of a public entity come. The tern "affiliate" includes those officers, directors, executives, partners,
<br />shareholders, employees, members, and agents who are active in the management of an affliate. The ownership by
<br />one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among
<br />persons when not for fair 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 has been convicted of
<br />a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.
<br />I understand that a "person" as defined in Paragraph 287.I33(t)(e), Florida Statutes, means any natural person or entity
<br />organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which
<br />bids or applies t bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts
<br />ot'itpplie'sT ra sact business with a public entity" 'fhe term "person" includes those offccrs, directors, executives, partners,
<br />sharehMYOZ-9� s, and agents who are active in management of any entity.
<br />U
<br />(Printed or Type d Legal Name of AfFant)
<br />Statc`o�takcoumyof t Q f ' 20010
<br />Sworn to and subscribed before me this �r day ofd - ;�99� by
<br />NL L �iUIYILUC (.L U_ , �0 ` Notary Seal:
<br />Notary's Name Printed, Stamped or Typed
<br />Personally Known:_ or Produced Identification _I___,
<br />Identification Produced L 1 A ` U 3X— AIR" 10W ..3CS-10 4`" - M. GAILOR
<br />MY COMMISSION N DO SM71
<br />?w i06 EXPIRES- January 1 o, 2oto
<br />1 a00SN0TARY FL Notery daaowd Argo. Co.
<br />Page 9 of 10
<br />06.03.01 Landscape Archifecrural Firm Bid
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