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Appendix Q SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(8) FLORIDA 5T A TUTES. ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AlITHORlZED TO ADMINISTER OATHS. \. This sworn statement is submitted to City of Sunny Isles Beach by G. Jerry Chiocca for Rachlin Cohen & Holtz LLP whose business address is One Southeast Third A venue, Tenth Floor Miami, Florida 3313 I and (if applicable) its Federal Employer Identification Number (FEIN) is 65-0544505 (IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: 2. I understand that a "public entity crime" as defined in Paragraph 287 .133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including. but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft. bribery, collusion, racketeering. conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defined in Paragraph 287. I 33(I)(b). Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt. in any federal or state trial court of record relating to charges brought by indictment or information after July I, 1989. as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contenders. 4. I understand that an "affiliate" as defined in Paragraph 287 . I 33(I)(a), Florida Statutes. means: a. A predecessor or successor of a person convicted of a public entity crime; or b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity come. The term "affiliate" includes those officers, directors. executives, partners, shareholders. employees, members, and agents who are active in the management of an affiliate. The o\\-TIership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. S. I understand that a "person" as defined in Paragraph 287 ,133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity. or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers. directors. executives, partners, shareholders. employees, members, and agents who are active in management of any entity. tA~~~"~ State of Florida County of Miami-Dade Sworn to and~subscribed before ~ this 4th day of ~cvL"~~~ G. Jerry Chiocca (Printed or Typed Legal Name of Affiant) May , 2007 by Teresa Cochran Notary's Name Printed. Stamped or Typed Notary Seal: Personally Known: X or Produced Identification O~l 't\. Teresa Cochran : ~ . My Commission 0023853-4 ~-) 0, ",I Expire5 November 28, 2007 4/312007 City of Sunny Isles Beach: Request for Proposal - Audit Services