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<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES
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<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OJ:or<fCIAL AlJI1-iOIUZED TO ADMfNlSTER OATHS,
<br />1. This sworn statement is submitted to The City of Sunny Isles Beach
<br />by HR Engineering Services, Inc,
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<br />for RFQ No, 07-03-01 Professional General Engineering Consultant
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<br />whose busincss address is 14038 NW 82nd Avenue, Unit 5, Miami Lakes, FL 33016
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<br />and (if applicable) its Federal Employer Identification Number (FEIN) is h 5.- () 7/-( q 633
<br />(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement:
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<br />2, I understand that a "public entity crime" as defined in Paragraph 287, I 33(1)(g), Florida Statutes, means a violation of
<br />any state or federal law by u person with respect to and directly related to the transaction of business with any public
<br />entity or with an agency or political subdivision of any othel' state or of the United States, including, but not limited to,
<br />any bid or contract for goods or scrvices to be provided Lo any public entity or an agency or political subdivision of allY
<br />other state or of the United States and involving antitrust, fraud, Ulcft, bribery, collusion, racketeering, conspiracy, or
<br />materialll1isrepresenUltion,
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<br />3, I understand that "convicted" or "conviction" as defined in Paragraph 287,133(l)(b), Florida Statutes means a finding
<br />of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial
<br />court of record relating to charges brought by indictment or jnformation after July I, 1989, as a result of a jury verdict,
<br />nOlUury trial, or 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), Florida Statutes, means:
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<br />a, A predecessor or successor of a person convicted of a public enlity crime; or
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<br />b. An entity under the control of any natural person who is active in the manugement of the entity and who has been
<br />convicted of a public entity come, The term "uffiliate" includes those ofticers, directors, ex.ecutives, partners,
<br />shareholders, employees, members, and agents who are active ill the management of an affiliate, The ownership
<br />by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income
<br />among persons when not for fair market value under an arm's length agreement, shall be II prima facie case that
<br />one person controls another perSOll, A person who knowingly enters into a joint venture with a person who has
<br />been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.
<br />5, I understand that a "person" as defined in Paragraph 287, I 33(1)(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
<br />which bids or applies to b' on contracts for the provision of goods OJ" services let by a public entity, or which
<br />ollierwise sacts or pi s to trar;:bUSiness with a public entity, The term "pcrso.n" includes tbose officers,
<br />directo', )\. cutives, par , share ers, employees, members, and agents who are active in mnnagement of any
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<br />cn';ly. / !h~ 12. !AM 5
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<br />(Printed or Typed Legal Name of Affiant)
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<br />State of FI rida County 0 \J.l()w- \):Ide. A I
<br />Sworn to and subscribed before me this ;2 'I d~IY of ~frJ(j ,2007 by
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<br />ELIZABETH TOR NELLI
<br />MY COMMISSION #OD601256
<br />EXPIRES: OCT 02, 2010
<br />Bonded through t 51 Slate Insurance
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<br />/ r/J I~ N I
<br />o I q,' otary Sea :
<br />Notal' Name Printed, Stamped or Typed
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<br />Personally Known: ~ or Produced Identification _Idcntification Produced
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<br />Page 8 of 9
<br />RFQ 07-03-01 Engineering Srvs Bridge Reviscd (Addcndum.l)
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