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<br />PUBLIC ENTITY CRIMES
<br />City of Sunny Isles Beach
<br />18070 Collins Avenue
<br />Sunny Isles Beach. FL 33160
<br />yr zu � *' - Telwphwna (305) 947.0606 Foy (305) 949-3113
<br />bVVUKN 7IAl EMGs i PORSOAN i 10 SECTION 287.133(3)(a)
<br />FLORIDA 5 I A I UTES, ON PUBLIC ENTITY CRIMES
<br />FOar_IC ER i I i r CRIIVIE5
<br />Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "m person or amliate
<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 />panlic eritit, for tic conut,aet;on or repair oT a paBlic building or public Work, may not submit Bids on leases of
<br />real property to a public entity, may not Be a-arBen to peRorm vvorR — G Contraoto., sapplier, Sub -Contractor, or
<br />Consultant unser a Contract with any puBlic entity, anB may not transact Business with any puBl;c entit,, in c�ct:3�
<br />of the threshold amount Category Two of Sec. aar.'u i i, FS for mirky six months from the date or Being places on
<br />the convicted vendor list".
<br />i RIs FORWI MOs i BE bIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICiRE Au i RORIt-ED 10 ADMiRla i ER OAI Rs.
<br />1. This sworn statement is submitted to City of sunny Isles eeacll
<br />by M t P f 1 Pcz-
<br />�rini individual's name and lidel
<br />dor ) ` _ u ti1L i.. t t
<br />romo .,c anAty 3tmmi?dng zr--.m al.+la—arLr
<br />whose Business address is:
<br />ana tiT applicaBle) itz Fcacr.l Employer 109 5141rc tion ne,,ber (FEIN) is c5q - 5127-
<br />33
<br />(h the entity nad no FEIN, incluse tae social secarity Mz;m5or oT Mo ii -Xi iaaal signing this sworn
<br />statement:
<br />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 />5a.ima3.witn any public entity or with an agency or political subdivision of any other state or with the
<br />Onitea states, inciuning, But not I;miitca to, -My Sia or t;ontract Tor goods or services to be provided to any
<br />puBlic entity or an agency or political suBaivision oT any otner state oT the Onitca ana intiol-�iny
<br />antitrust, fraud, theft, bribery, collusion, racReteering, conspiracy, or material misrepresentation.
<br />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 />icdcral or mate ti=Qii coag at rcoora relating to charges brought by indictment or information after July 1,
<br />I gag, as a result of a jury veraim, non -jury trial, or crit. yy oT a pica oT guilty or nolo contendere.
<br />I understand that an "affiliate" as defined in Para. car. ta3j 11{a), Florida Statutes, means:
<br />a.) predecessor or successor of a person convicted of a public entity crime; or
<br />B.) An, entity aniaor tlio control of any nataral person who is active in the management of the entity
<br />ana wno Bas Been convicted or a puBlic entity crime. i Re torrrl ".niliate" i,nvIedws triose aficers,
<br />directors, executors, paRners, snarellolders, employees, memBers, anB agents wllo are active in
<br />the management of an affiliate. The ownership by one person of snares constituting a controlling
<br />interest in another person, or a pooling of equipment or income among persons when not for fair
<br />2 of 10
<br />Lukes' Landscaping; Inc.
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