|
<br />I
<br />
<br />APPENDIX G
<br />
<br />I
<br />
<br />SWORN STATEMENT PURSUANT TO S287.133(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
<br />OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br />
<br />I
<br />
<br />I
<br />
<br />1.
<br />
<br />This sworn statement is submitted to:
<br />by:
<br />for:
<br />whose business address is:
<br />
<br />City of Sunny Isles Beach, Florida.
<br />William G. Benson, C.P.A., Partner
<br />Keefe, McCullough & Co., LLP
<br />6550 North Federal Highway, Suite 410
<br />Fort Lauderdale, Florida 33308
<br />
<br />I
<br />
<br />and (if applicable) its Federal Identification
<br />Number (FEIN) is:
<br />
<br />59-1363792
<br />
<br />I
<br />
<br />2.
<br />
<br />I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
<br />violation of any state or Federal law by a person with respect to and directly related to the transaction of business
<br />with any public entity or with an agency or political subdivision of any other state or with the United States,
<br />including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an
<br />agency or political subdivision or any other state or of the United States and involving antitrust, fraud, theft,
<br />bribery, collusion, racketeering, conspiracy or material misrepresentation.
<br />
<br />I
<br />
<br />3.
<br />
<br />I understand that "convicted" or "conviction" as defined in Paragraph 287. 133(1)(b), Florida Statues means a
<br />finding of guild or a conviction of a public entity crime, with or without an adjudication of guild, in any federal
<br />or state trial court of record relating to charges brought by indictment or information after July I, 1989, as a result
<br />of a jury verdict, non-jury trial. or entry of a plea of guilty or nolo contendre.
<br />
<br />I
<br />
<br />I
<br />
<br />4.
<br />
<br />In understand that an "affiliated" 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 />I
<br />
<br />b.
<br />
<br />An entity under the control of any natural person who is active in the management of the entity and who
<br />has been convicted of a public entity crime. The term "affiliate" includes those officers, directors,
<br />executives, partners, shareholders, employees, members, and agents who are active in the management
<br />of an affiliate. The ownership by one person of shares constituting a controlling interest in another
<br />person, or a pooling of equipment or income among persons when not for fair market value under an
<br />arm's length agreement, shall be a prima-facie case that one person controls another person. A person
<br />who knowingly enters into a joint venture with a person who has been convicted of a public entity crime
<br />in Florida during the preceding 36 months shall be considered an affiliate.
<br />
<br />I understand that a "person" as defined in Paragraph 287 . 133(1)(e), Florida Statutes, means any natural person
<br />or any entity organized under the laws of any state or of the United States with the legal power to enter into a
<br />binding contract and which bids or applies to bid on contracts led 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,
<br />executives, partners, shareholders, employees, members, and agents who are active in management of an entity.
<br />
<br />I
<br />
<br />I
<br />
<br />5.
<br />
<br />I
<br />
<br />
<br />I
<br />
<br />I
<br />
<br />I
<br />
<br />State of Florida)
<br />) ss.
<br />County of Broward)
<br />
<br />BEFORE ME, this 2nd day of May, 2007, by William G. Benson.
<br />
<br />"" "It,
<br />~*,!;r;1.....~.. Beth C. Anderton
<br />.~')~ C
<br />;:\ .: ommlaslon" 00411838
<br />~ .,/ l Expires October 1 200i
<br />, .i" AaR'" fli, ,.~ IA'WflftU 1116 _f~li
<br />
<br />I
<br />
<br />I
<br />
<br />
<br />Notary Seal:
<br />
<br />I
<br />
<br />Personally Known X
<br />
<br />or Produced Identification
<br />
<br />Identification produced
<br />
|