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<br />SWORN S1' A TEMENT 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 />l. This sworn statement is submitted to The City of Sunny Isles Beach
<br />
<br />by Consulting Engineering & Science, Inc.
<br />
<br />for RFQ No. 07-03-01 Professional General Engineering Consultant
<br />
<br />whose business address is 8925 SW 148th Street, Suite 100, Miami, FL 33176
<br />
<br />and (if applicable) its Fcderal Employer Identification Number (FEIN) is LS , -,j 0 1 S" I~
<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(1)(g), Florida Statutes, means a violation of
<br />any state or federal law by a person with respect to and directly relatcd 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 Unitcd Statcs 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 287.133(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 rcsult of a jury verdict,
<br />nOI~ury trial, or entry of a plea of guilty or nolo contendcrs.
<br />
<br />4, I undcrstand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:
<br />
<br />a. A predecessor or successor of a persoll 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 287.133(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, partners, shareholders, employees, members, and agents who are active in management of any
<br />
<br />
<br />,,,,;,y~ II. J'JI6lII ~
<br />S;t~A . O~T ',.r
<br />
<br />State of .flonda County of 1v\(O.fV\...I ~
<br />Sworn to and subscribed before me this 24-t:::Ldayof f\()r I {
<br />'0e W~ (\Aor (0 s
<br />
<br />/ 'GLQ.~
<br />ame Printed, Stamped or Typed
<br />
<br />Personally Known: V
<br />
<br />'j e..(+(~c.(,4.J
<br />
<br />(Printed or Typed Legal NUl e of AfI1ant)
<br />
<br />, 2007 by
<br />
<br />
<br />Notary Seal:
<br />
<br />~ ~ Grace MoraleS
<br />! ~ . My Commisslon 00267142
<br />
<br />~,,'J;..ol Expires November 16. 2007
<br />
<br />Nota
<br />
<br />or Produced Identification _Identification Produced
<br />
<br />Page 8 of 9
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum. I)
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