|
ti4,iK 11j,
<br />PUBLIC ENTIT=Y CRIMES.
<br />City of Sunny Isles Beach
<br />=� � * •, 16070 c. IM kverx»
<br />•'.. f �� • � *' 5timy lsUa Beach, FJ- 33M
<br />00 F. o. L Milo T04OKsw {313} 947.66M Far. (345)94-3113
<br />SWORN STATEMENT PURSUANT TO SECT101Y 287.133(3)(a) .
<br />FLORIDA STATUTES, CIM PUBLIC ENTITY CRIMES
<br />RUt3LIC ENTITY CRIMES
<br />Pursuant to the provisions of paragraph (2) (a) of $edioa 297.133, Florida State Statutes - "A person or affiliate
<br />who has been placed on the convicted vendor Iist fol lowiriq 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 wilco 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 Corntrsotor, supplier, Sub -Contractor, or
<br />Consultant under 0ontract with any public entity, and may not transact business with any public entity in exOesS
<br />sof the threshold amount Category Two of Sec. 287.017. FS for thirty six months: from the date of being pWced on
<br />the convicted vendor list".
<br />THIS FORM MUST 13E $1 NED AND SWARM TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORIZED T40 ADMINISTER OATHS.
<br />11,1. This sworn statement is submitted to City of sunny Is1es-8aach .. _ __.
<br />o,y Ja5on R, Wells, President
<br />MuL-musp S nwn
<br />for Jacey Investments, L.L.C. dJbla Elite Tent Company _
<br />PrV11 name Ca OnMy eu b rEd=g asnvrn SUrmnen�
<br />whose business address is;
<br />2375 S.W. 58th Avenue
<br />West Park, FL 33023
<br />and (if applicable) its Federal Employer Identification number (FEIN) is .20-538840 8
<br />(it the entity had no FEIN, include the Social Security Number of the indMdusl signing this sworn
<br />77:2. 1 understand that a "public entity crime" as defined in Paragraph 287,733(1)(9), F=lorida Statutes, rnyans a
<br />uiolafion of any state or federal law by a person with respect to and directly related to tha traos-�edon of
<br />business with any public enfity or with an agency or political subdivision of any other etate or with the
<br />Urdted States, Including; but not limited to, any Bid or Contract for goods or services to be provided to any
<br />public erltit+y or an agenoy or political subdivision of any other state of the United States and involving
<br />anti,rust; traud, theft; brib", oollusion, racketeering, conspiracy; or malerial misrepresentation.
<br />1148. 1 understand that "convicted" or'"convieiian" as defined in Paso, 47,1133(7)(b), Florida Statutes, means a
<br />finding of guitt or a conviction of a public eatity creme, with or without an adjudication of guilt, in any
<br />federal or state trail court of repord relating to charge -s brought by indictment or Information after July t,
<br />19898 as a result of a jury verdict; non�ury trial; or entry of a plea of guilty or nolo carltehdere.
<br />%4s t understand t#iat an "affiliate"as deFned in Para, 287.133(1)(a), Florilda statutes; means.,
<br />a,) peedectssor or socrAgs6t of a person ouhvicted of a public entily cd me; or
<br />b.) Arty entity under the control of boy nftkueal rAme i who is active in the mansgernent of th6 entity
<br />,snd whe fiat haen convicted of a public entity crime. The tetm "afTdiate'' includes those &fr�4rs,
<br />directors, executors, partner, shareholders, anrlptoyees, rnernbets, and agents who are active 1n
<br />the rmanagernent of an affiliate, The awtinrthip by ont3 pemon of s4ures cohsiituting a controllino
<br />interest in another person, or a pooling of equipment or income among penins when not for fair
<br />2 of 7
<br />
|