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<br />
<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(3)
<br />FLORIDA STATUTES, ON PUBLIC ENTlTY CRIl\rES
<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 The City Of Sunny Isles Beach
<br />
<br />by Oracia Riccobono
<br />
<br />for Geosol, Inc.
<br />
<br />whose business address is 5795-A NW 151 st Street Miami Lakes, Fl 33014
<br />
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 65-0997886
<br />(IF the entity had no FEIN, include tl1e 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 Jaw 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 Slates, 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 287.133(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 rei ating 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 ,133(1)(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 [air 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, executiv(':s, partners, shareholders, employees, members, and agents who are active in management of any
<br />entity..' ,-
<br />
<br />Gracio Riccobono
<br />(Printed or Typed Legal Name of Affiant)
<br />? ," 1
<br />State of F-L County of L.J/~""'(.I-1c...-,- )1 ,.'
<br />Sworn to and subscribed before me this ,.:;;~_ day of -L=b') iI' (
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<br />f Notary's Name Printed, Stam
<br />
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<br />
<br />SiGNATURE OF AFFIANT
<br />
<br />, 2007 by
<br />
<br />
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<br />
<br />ed or Typed
<br />
<br />Notary Seal:
<br />
<br />Personally Known:
<br />
<br />or Produced Identification X
<br />
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<br />Identification Produced FL D.L, # R215-640-64-267-0
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<br />Page 8 of9
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<br />RFQ_Eng_Srvcs_Fur_Gov_lnjrastrtlcutre_042407[ J J
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