|
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br /> FLORIDA STATUTES,ON PUBLIC ENTITY CRIMES
<br /> THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR
<br /> OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br /> 1 . This svom statement is submitted to City of Sunny Isles Beach, Florida
<br /> by John Peterson, General Manager/VP _
<br /> for Quality Communications Fire & Security, Inc.
<br /> whose business address is 3700 SW 30 Avenue
<br /> Ft Lauderdale, FL 33312
<br /> and if applicable) its Federal Employer Identification Number(FEIN) is 01-0618381 _
<br /> (IF the entity had no FEIN,include the Social Security Number of the individual signing this sworn statement:
<br /> 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(I)(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 of the United
<br /> States, including, but not limited to, any bid or contract for goods or sen-ices to be provided to any public
<br /> entity or an agency or political subdivision of any other state or of the United States and involving antitrust,
<br /> fraud, theft,bribery,collusion,racketeering,conspiracy,or material misrepresentation.
<br /> 3. 1 understand that "convicted" or"conviction" as defined in Paragraph 287.133(I)(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 federal
<br /> or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a
<br /> result of a jury verdict,nonjury trial,or entry of a plea of guilty or nolo contenders.
<br /> 1' 4. I understand that an "affiliate"as defined in Paragraph 287.133(I)(a),Florida Statutes,means:
<br /> a. A predecessor or successor of a person convicted of a public entity crime;or
<br /> b. An entity under the control of any natural person who is active in the management of the entity and who
<br /> has been convicted of a public entity come. The term "affiliate" includes those officers, directors,
<br /> executives,partners, shareholders, employees,members,and agents who are active in the management of
<br /> an affiliate. The ownership by one person of shares constituting a controlling interest in another person,
<br /> or a pooling of equipment or income among persons when not for fair market value under an arm's
<br /> length agreement, shall be a prima facie case that one person controls another person. A person who
<br /> knowingly enters into a joint venture with a person who has been convicted of a public entity crime in
<br /> Florida during the preceding 36 months shall be considered an affiliate.
<br /> 3. I understand that a "person" as defined in Paragraph 287.133(I)(e), Florida Statutes, means any natural person
<br /> or entity organized under the laws of any state or of the United States with the legal power to enter into a
<br /> binding contract and which bids or applies to bid on contracts for the provision of goods or sen-ices let by a
<br /> public entity, or which otherwise transacts or applies to transact business with a public entity. The term
<br /> "person" includes those officers,directors,executives,partners,shareholders,employees,members,and agents
<br /> u-ho are active in man •ement of any entity.
<br /> 1 4-30-04
<br /> Signature Date
<br /> Sworn to and subscribed before me this 30th day of April , 2004, by
<br /> John Peterson who is peroQ t1 i known to7 or has provided
<br /> nl�/ J ' as identification.
<br /> •
<br /> allotary Sealc „ Cari Breaban
<br /> 4'.Commission 4DD174692 n
<br /> Signature
<br /> Expires:Oct 05,2004
<br /> - r Bonded Thru
<br /> '•''dui a ' Atlantic Bonding Co.,Inc.
<br />
|