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Corzo, Castella, Carballo
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(07-03-01) General Engineering Services
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Corzo, Castella, Carballo
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Last modified
1/26/2011 2:25:47 PM
Creation date
1/26/2011 2:25:23 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Engineering Svcs.
Bid No. (xx-xx-xx)
07-03-01
Project Type (Bid, RFP, RFQ)
RFQ
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<br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br />I <br /> <br />I <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 OFFICIAL <br />AUTHORIZED TO ADMINISTER OATHS: <br /> <br />I. <br /> <br />This sworn statement is submitted to City of Sunny Isles Beach <br />by Robert T. Carballo. PE. President <br />for Corzo Castella Carballo Thompson Salman. PA (C3TS) <br />whose business address is 3996 NW 9th Avenue, Fort Lauderdale, Florida 33309 <br />and (if applicable) its Federal Employer Identification Number (FEIN) is 65-0039493 <br />(IF the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: <br /> <br />2. <br /> <br />I understand that a "public entity crime" as defined in Paragraph 287.133( I )(g), Florida Statutes. 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 />misrepresentations. <br /> <br />3. <br /> <br />I understand that "convicted" or "conviction" as defined in Paragraph 287 .133( I )(b), Florida 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 I, 1989, as a result of ajury verdict, nonjury uial, <br />or entry of a plea of guilty or nolo contendere. <br /> <br />4. <br /> <br />I understand that an "affiliate" as defined in Paragraph 287.133( I )(a), Florida Statutes. means: <br /> <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 crime, 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 by one <br />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 lenglh agreement, shall be a prima facia case that one person <br />controls another person. A person who knowingly enters into ajoint venture with a person who has been convicted of a <br />public entity crime in Florida during the preceding 36 months shall be considered an affiliate. <br /> <br />5. <br /> <br />I understand that a "person" as defined in Paragraph 287.133( I )(e), Florida Statutes, means any natural person or entity <br />organized under the laws of any slate or of the Uniled States wilh the legal power to enter into a binding eontract and which <br />bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts <br />or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, paI1ners, <br />harehoiders;-em oyees, members, and agents who are active in management of an entity. <br /> <br />Robert T. Carballo, P.E, <br />(Printed or Typed Legal Name of Affiant) <br /> <br />I <br /> <br />State of Florida County of Miami-Dade <br />Sworn to and subscribed before me this 24~ <br /> <br />day of <br /> <br />APri I <br /> <br />, 2007 by <br /> <br />I <br /> <br />I <br /> <br /> <br />Notary Seal: <br /> <br />." P'V. Grace 6S <br />O'~t'1o <br />" . My Commission 00267742 <br />~")f ,~j ExpIres November 16. 2007 <br /> <br />-./ <br /> <br />Personally Known: <br /> <br />I <br /> <br />or Produced Identification <br /> <br />Identification Produced: <br />
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