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PUBLIC ENTITY CRIMES City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947-0606 Fax: (305) 949-3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to tha provisions of paragraph (2) (a) of Section 287. t 33, Florida Stete Statules - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or servicas to a public enmy, may not submit a Bid on a Contract wilh a pUblic entity for the construction or repair of a public building or public Work, may not submit Bids On leases of real proparty to a public entily, may not be awarded to perform Work as a Conlractor, supplier, Sub-Contractor, or Consultant under a Contract with any public entity, and may nol transact business with any public entity in excess of the threshold amount Category Two of Sac. 287.017, FS for thirty six months from the date of being placed on the convicted vendor iist". 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 s by for whose business address Is: and (if applicable) its Federal Employer dentificatlon number (FEIN) Is 0 I - -, (If the entity had no FEIN, include 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 stale 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 slate of lhe United States and Involving antilrust, fraud, theft, bribery, collusion, racketearing, conspiracy, or material misrepresentation. 11.3. I understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, maans 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 racord relating to charges brought by indictmenl or information after July 1, t 989, as a result of a jury verdict, non-jury triel, or entry of a plea of guilty or nolo contendere. 11.4. I undarstand that an "affiliate" as dafined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a parson convicted of a public entity crime; or b.) Any entity under the controi of any naturel 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 20f7 OECEMBER2B.201C f' .) ':;) ,.)