|
<br />.
<br />
<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
<br />
<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br />
<br />1. This sworn statement is submitted to City of Sunny Isles Beach
<br />
<br />O~O /l{~NO
<br />for beO!OL, INC.
<br />whose business addre;s is 5 7C/>=- A N0 /r-I 'f.f ~rllEE r
<br />M I frM I LIfUS, {{,. 3301'1
<br />
<br />by
<br />
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is G ~-oqq 7Rf6
<br />(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement:
<br />
<br />2, I understand that a "public entity crime" as defined in Paragraph 287.133(l)(g), Florida Statutes, means a violation of
<br />any state or federal law by a 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 other state or of the United States, including, but not limited to,
<br />any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any
<br />other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or
<br />material misrepresentation,
<br />
<br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287,1 33(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 information after July I, 1989, as a result of a jury verdict,
<br />nonjury trial, or entry of a plea of guilty or nolo contenders.
<br />
<br />4. I understand that an "affiliate" as defined in Paragraph 287,1 33(I)(a), Florida Statutes, means:
<br />
<br />. a. A predecessor or successor of a person convicted of a public entity crime: or
<br />
<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 term "affiliate" includes those officers, directors, executives, partners,
<br />shareholders, employees, members, and agents who are active in 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 a prima facie case that
<br />one person controls another person. 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(l)(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 bid on contracts for the provision of goods or services let by a public entity, or which
<br />otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers,
<br />directors, executives, panners, shareholders, employees, members, and agents who are active in management of any
<br />entity/! j '. /
<br />
<br />~ tJ/ltttto !ltUv60f\.JO
<br />
<br />SIGNATURE OF AfFIANT (Printed or Typed Legal Name of Affiant)
<br />
<br />State of Florida County of Miami- Dade ~\\\\~~~~"~IIIII/.
<br />. . 24 h A '1 ? ~""0 ....... ~I\t,~/.
<br />Sworn to and subscnbed before me thIS t day of prl ,_007 by ~~...;",\.I.\SSlONc;-~..Q ~
<br />~ .'.i\,? 13, 200"1/.' ~
<br />~:~ ~..~
<br />Oracio Riccobono - . . -
<br />';*: ... :*-
<br />Willie Wan Notary Seal: ~ '. #DD244460 :
<br />....~ ~..-
<br />Notary's Name Printed, Stamped or Typed \:tv;"'f',"""AtJ';al1~~...~#..:;,-~
<br />
<br />Personally Known: or Produced Identification V"Identification Produced ft DUt 7{l~ii~~Z6 7-0
<br />
<br />. Page 80f9
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum, I)
<br />
<br />
|