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SWORN STATEMENT PURSUANT TO SEC'nON 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENltTY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. this sworn statement Is submitted to Otv of Sunnv Isles Beach Cltv Commission by (\1 A ('l j \+~ (r~ al' n - 0 (t) {\ () ( ~tihej J for tlt\\ I ) I I) ~ Y\U l7 [print ~ submitllng ~ statement) whose business address Is: U 3 0, ,- p () I'\A ~.ht\O j)~( IL U17-LL (~ () 2-. ~ () t\J'.fo.r-. 0 &P~ r: (_ "3 r1 () ~ q and (If applicable) its Federal Employer Identification number (FEIN) is ? r) - if~ / S 972 (If the entity had no FBN, indude the Social Security Number of the individual signing this sWorn statement: .) 11.2. 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 with 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 of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. I understand that "convicted" or "conviction" as defined in Para. 287.133(l)(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 trail court of record relating to charges brought by indicbnent or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere. 11.4. I understand that an "affiliate" as defined In Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime; or b.) Any 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 crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active In the management of an affiliate. The ownership 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 prime fade 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. 11.5. I understand that a "person" as defined In Para. 287.133(1)(e), Rorida 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 "persons" Includes those officers, directors, PAGE 58 OF 78