HomeMy WebLinkAbout17. Public Entity Crimes FormPUBLIC ENTITY CRIMES
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33180
Telephone: (305) 947-0606 Fax: (305) 949-3113
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
PUBLIC ENTITY CRIMES
Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate
who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a
Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a
public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of
real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub -Contractor, or
Consultant under a Contract with any public entity, and may not transact business with any public entity in excess
of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on
the convicted vendor list
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
11.1. This sworn statement is submitted to City of Sunny Isles Beach
by Cl tpnn S�'U individual name ande A ail L (�(AreKK
for
tpnni name or entity submitting sworn statementJ
whose business address is:
& )` )r`a; . PG 333 ,
and (if applicable) its Federal Employer Identification number (FEIN) is H '"I-Li+ol 11360
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: W %A }
11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or with the
United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any
public entity or an agency or political subdivision of any other state of the United States and involving
antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any
federal or state trail court of record relating to charges brought by indictment or information after July 1,
1989, as a result of a jury verdict, non -jury trial, or entry of a plea of guilty or nolo contendere.
11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means:
a.) predecessor or successor of a person convicted of a public entity crime; or
b.) Any entity under the control of any natural person who is active in the management of the entity
and who has been convicted of a public entity crime. The term "affiliate" includes those officers,
directors, executors, partners, shareholders, employees, members, and agents who are active in
the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
DECEMBER 28, 2010