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<br /> ® ,. PUBLIC ENTITY CRIMES
<br /> ® ��,-,� City of Sunny Isles Beach
<br /> ® 1'" 18070 Ca7ins Avenue
<br /> f`pr''•stoR`oo•`` Sunny hies Beachh,FL 33160
<br /> ® ''or ivy ''.4 Telephone:(30 5)94 7-060 6 Fax:(305)940.3113
<br /> ® SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br /> ® FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
<br /> ® PUBLIC ENTITY CRIMES
<br /> 5 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 crime 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 Contract 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 /> CO THIS FORM MUST BE SIGNED AND SWORN TO IN 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 /> ®® by Ne cJie/Ie /'"/Ora/P.S 7""I'P.S/CIP(T�
<br /> (pent marl Guars name ano Lite,
<br /> ® for Pieshic. Ari-o lrrnoo✓- - owin j .f vee •very _The .
<br /> ® (pent n entry sunmarng sworn=tem 4
<br /> whose business address is:
<br /> ® Rig/ M / - O c r(P-/' No r--1-11 Miami FL_ ,3 £6,1
<br /> and (if applicable)its Federal Employer Identification number (FEIN)is
<br /> 45-259-5305
<br /> ® (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
<br /> ® statement: .)
<br /> ® 2. I 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 /> ® 3. I 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 /> el 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 nolo contendere.
<br /> ® 4. I understand that an"affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means:
<br /> 0 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 /> 0 interest in another person, or a pooling of equipment or income among persons when not for fair
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