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<br /> I • SUNNY rs,E .
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<br /> _ _ 'PUBLIC ENTITY CRIMES
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<br /> .•�• City of Sunny Isles Beach
<br /> • � - or 18070 Collins AvenueS`c '•ri.o*��o 4. Sunny Isles Beach,FL 33160
<br /> c'''0,or.UN' Telephone:(305)947-0606 Fax(305)949-3113 •
<br /> SWORN STATEMENT PURSUANT TO SECTION 287.133(3)0) -
<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 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 /> I 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 forthirty six months from the date of being placed on
<br /> the convicted vendor list".
<br /> ITHIS 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 /> M. by Steven Glenn,Vice President
<br /> [print individual's name and title] '
<br /> I for Tidal Basin Government Consulting,LLC
<br /> [print name of entity submitting sworn statement]
<br /> whose business address is:
<br /> 126 Business Park Drive,Utica,NY 13502
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<br /> and(if applicable)its Federal Employer identification number(FEIN)j5.20-5926493 '
<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 /> I 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 /> I 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 /> I 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 nolo contendere.
<br /> 1 4. I 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 convictedof 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 /> I interest in another person, or a pooling of equipment or income among persons when not for fair
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