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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 />OFFICIAL AUTHORIZED TO ADMINISTER OATHS,
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<br />1. This sworn statement is submitted to City of Sunny Isles Beach
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<br />by M;:mllP 1 l, Vpr;:J
<br />fur Manuel G Vera & Associates, Inc.
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<br />whose business address is
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<br />13960 SW 47th Street, Miami, FL 33175
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<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 59-1 741 6'3 q
<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 287.133(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.
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<br />3, I understand that "convicted" or "conviction" as defined in -Paragraph 287. I 33(1)(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,
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<br />4. I understand that an "affiliate" as defined in Paragraph 287,133(l)(a), Florida Statutes, means:
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<br />a, A predecessor or successor of a person convicted of a public entity crime; or
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<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, 1 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,
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<br />~:~ka~' emplOY"', mem:~:~::g:":~::,, ,ct've in m'"'g,m,nt of 'ny
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<br />ATURE OF AFFIANT (Printed or Typed Legal Name of Affiant)
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<br />State of F/Ot-ldC\ County of /v110iYlI
<br />Sworn to and subscribed before me this ~f/l
<br />
<br />/YJ!JJ1 tit I (; _ Ve.eC\
<br />~twiA/ AlViil
<br />
<br />Notary's Name Printed, Stamped or Typed
<br />
<br />day of
<br />
<br />Hpll i I
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<br />, 2007 by .....,
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<br />Notary Seal:
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<br />Personally Known:
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<br />v
<br />
<br />or Produced Identification _Identification Produced
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<br />Page 8 of9 .
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum.I)
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