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<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 />I, This sworn statement is submitted to
<br />
<br />City of Sunny Isles Beach
<br />
<br />by Mi'll111Pl G \TPTi'l
<br />fur Manuel G Vera & Associates, Inc.
<br />
<br />whose business address is
<br />
<br />13960 SW 47th Street, Miami, FL 33175
<br />
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 5 9 - 1 7 Lll h 1 q
<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 "Pllblic entity crime" as defmed 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. 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-ro 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. I 33(1)(a), Florida Statutes, means:
<br />. - . I
<br />a, A predecessor or successor of a person convicted of a public entity"crime; o'r,
<br />
<br />b, An entity under the control of any natural person who t? actiV"e 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 />d irectors'1 executives, partners, ~hareholders, employees, members, and agents who are active in management of any
<br />entity. /I ,; to/:
<br />
<br />/, /1:/ /c.'. (" / IFj~t!-c_~ Manuel G Vera
<br />S G ATURE OF AFFIANT (Printed or Typed Legal Name of Affiant)
<br />
<br />Stat of F lor?..Ic((l County of /L /r (IIL'/ ;
<br />Sworn to and subscribed before me this ,;)(/1 h day of
<br />
<br />!l/1(U7u-( / 6. UP 12/1
<br />').'; - \'--:;1-. 1 ;--, ,,/
<br />(.;./ ).j /" IJ j/ I
<br />Notary's Name Printed, Stamped or Typed
<br />I
<br />,/
<br />
<br />
<br />j1L"Ii.!j /
<br />,
<br />
<br />, 2007 by
<br />
<br />Notary Seal:
<br />
<br />;-' . r " .. . . 0 . . ~ . r r r " " . , . .. I. . ,. ~
<br />'. S(LVI/\ N'uIN.UGI..uu...'t
<br />
<br />........~,~yll;~I'I';~ CommtJ 000446800
<br />'''''~'''G<
<br />g:' '':'; Expir'es 9/2412009
<br />~ \:/1',.:' ~~g Bonded thru (800)432-4254 E
<br />: "IIR!I~\'~" FlOrida No . :
<br />"'lI QQQQQIIOllOllQO Q ao (I I (I (I Q allO II !l1l;;~O~;~ll~';lIl~ll~ll~
<br />
<br />Personally Known:
<br />
<br />or Produced Identification _Identification Produced
<br />
<br />Page 8 of 9 .
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum,])
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