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<br />Appendix G
<br />
<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES
<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 City of Sunny Isles Beach
<br />by Antonio J. Grau
<br />for Professional Audit Services (RFP # 07-04-01)
<br />whose business address is 2700 North Military Trail, Suite 350, Boca Raton, FL 33431
<br />
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 20-2067322
<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 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 287.133(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 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
<br />has been convicted of a public entity come. The term "affiliate" includes those officers, directors,
<br />executives, partners, shareholders, employees, members, and agents who are active in the
<br />management of an affiliate. The ownership by one person of shares constituting a controlling interest in
<br />another person, or a pooling of equipment or income among persons when not for fair market value
<br />under an arm's length agreement, shall be a prima facie case that one person controls another person.
<br />A person who knowingly enters into a joint venture with a person who has been convicted of a public
<br />entity crime in Florida during the preceding 36 months shall be considered an affiliate.
<br />
<br />5. I understand that a "person" as defined in Paragraph 287.133(I)(e), Florida Statutes, means any natural
<br />person or entity organized under the laws of any state or of the United States with the legal power to enter
<br />into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let
<br />by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term
<br />"person" includes those officers, directors, executives, partners, shareholders, employees, members, and
<br />ag.:9.e ts who are active in management of any entity.
<br />/~ ~~ Antonio J. Grau
<br />SIGN_ URE OF AFFIANT (Printed or Typed Legal Name of Affiant)
<br />
<br />State of :rt012.1 cLCt..--County of if'a)n\ BeAd,
<br />Sworn to and subscribed before 1 day of i-{~
<br />
<br />
<br />, 2007 by
<br />
<br />
<br />Notar
<br />
<br />1I%rl~C4{<--
<br />
<br />SANDRA D. BLACKMAN
<br />MY COMMISSION # DD 572289
<br />EXPIRES: August 14, 2010
<br />Bonde<! Thru Notary Pub,c Underwrite's
<br />
<br />Notary's Name Printed, Stamped or Typed
<br />
<br />...,I'I~tJ~.",
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<br />.,.t..,,"
<br />
<br />Personally Known:
<br />
<br />.,/
<br />v
<br />
<br />or Produced Identification
<br />
<br />Identification Produced
<br />
<br />4/23/2007
<br />
<br />City of Sunny Isles Beach: Request for Proposal - Audit Services
<br />
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