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<br />PUBLIC ENTITY CRIMES
<br />City of Sunny Isles Beach
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<br />F bpe��V °r Sunny Isles Beach, FL 33160
<br />I Put prie TeleAhonw. (306) 847.0600 Fax; (305) 8494113
<br />SWORN STATEMENT PUia,S UANTTO SECTION 287.333(3)(x)
<br />FWRIDA STATUTES, ON PUBLIC ENTrff CRIMES
<br />PUBLIC ENTITY CRIMISS
<br />Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or afillate
<br />who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a
<br />Bid on a Contract to provide any goods or services to a public entity, may not submh.e Bid on a Contract with a
<br />public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of
<br />real property to a public entity, may not be awarded to perform Work as a Contractor. supplier, Sub-Contractor, or
<br />Consultant under a Contract with any public entity, and may not transact business with any public entity In excess
<br />of the threshold amount Category 7Wo of Sec. 287.017, FS for Utirty six months from the date of being placed on
<br />the convicted vendor ilst".
<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORiZ.ED TO ADMINISTER OATHS.
<br />11.1.
<br />for ,SdQ 1 `L (.
<br />whose b sines addr as I r �.
<br />and (if applicable) its Federal Employer identification number (FEIN) Is
<br />(If the entity had no FEiN, Include the Social Security Number of file individual signing this sworn
<br />statement: ,)
<br />11.2. 1 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
<br />business with any public entity or with an agency or political subdivision of any other state or with the
<br />United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any
<br />public entity or an agency or political subdivision of any other state of the United States and Involving
<br />antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
<br />11.3. 1 understand that "convicted" or "conviction" as defined In Para. 287.133(1)(b), Florida Statutes, means a
<br />finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, In any
<br />federal or state trail court of record relating to charges brought by indictment or Information after July 1,
<br />1989, as a result of a Jury verdict, non Jury trial, or entry of a plea of guilty or polo contenders.
<br />11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means:
<br />a.) predecessor or successor of a person convicted of a public entity crime; or
<br />b.) . Any entity, under the control of any natural' person who Is active in the management of the entity
<br />and who has been convicted of a public entity crime, The term "affiliate" Includes those officers,
<br />directors, executors, partners, shareholders, employees, members, and agents who are active In
<br />the management of an affiliate. The ownership by one person of shares constituting a controlling
<br />Interest In another person, or a pooling of equipment or Income among persons when not for fair
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