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'ANN, ='<<
<br />YUBLlt„ 1:N'111 Y CRIMES
<br />City of Sunny Isles Beach
<br />18070 Colt n_ A_ens.
<br />• c -o'` o+`�
<br />Sammy I legBeoeh, FL 3:,av
<br />-� ., ;■-'� Te;ephane {305; 947-0606 Fax j3751 949-3113
<br />-)vvVRla � i A i EMEA i P13KS13AII I i O SECTION 287.133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
<br />PUBLIC ENTITY CRIMES
<br />Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate
<br />who has been placed on the convicted vendor list following a conviction for a public entity Grime may not submit a
<br />Bid on a Contract to provide any goods or services to a public entity, may not submit a 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 Cc;ntraLt with any public entity, and may not transact business with any public entity in excess
<br />of the threshold amount Category Two of Sec_ 287.017, FS for thirty six months from the date of being placed on
<br />the convicted vendor list"_
<br />THIS FORM MUST BE SIGNED AND SWORN TO 1N THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br />1. This sworn statement is submitted to City of Sunny Isles Beach
<br />MA
<br />I
<br />[print Mm■ -M litivi ,
<br />for
<br />feet "--A d TRW7 wbmitt" :—m : `■;C;:t � - -
<br />whose business address is:
<br />and (if applicable) its Federal Employer Identification number (FEIN) is
<br />(If the entity had no FEIN, include the Social Security Number of the indiviauai signing this sworn
<br />statement: }
<br />2. 1 understand that a "public entity crime" as defined in Paragraph 287.133 1)tg), Floricia Statutes, means a
<br />violation of any state or federal law by a person with respect to ane Directly reiated to the transaction or
<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 provieed to any
<br />public entity or an agency or political subdivision of any other state of the unites States and involving
<br />antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy_ or material misrepresentation.
<br />I understand that "convicted" or "conviction" as defined in Para. ca i _ i aak 1)A, Rloritla statutes, means a
<br />finding of guilt or a conviction of a public entity crime, wiLM or witnout an adjutlication or guilt, in any
<br />federal or state trail court of record relating to charges 0rougilt By insictment or intormation atter uuly t,
<br />1989, as a result of a jury verdict, non -jury trial, or entry of a plea or gui,ty or nolo contendere.
<br />4. 1 understand that an "affiliate" as defined in Para. `a7. 1a3(t)�a), >=lorisa Statutes, means:
<br />a a predecessor or successor of a person convicted of a pulslic entity crime; or
<br />b.) Any entity under the control of any natural person wllo is active in the management or the entity
<br />and who has been convicteu of a pu5iic entity crime. 1 Ile term "anlliate" includes Inose orlicers,
<br />directors, executors, partners, snarellotders, employees, memuers, ono agents wllo are active in
<br />the management of an affiliate. Tne ownership uy one person or snares constituting a controlling
<br />interest in another person, or a pooling of equipment or income among persons when not for rair
<br />L or in i
<br />Luke3' Landscaping, Inc.
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