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<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3}(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIl'dES
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<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORIZED TO ADMINISTER OATHS,
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<br />1. This sworn statement is submitted to City of Sunny Isles Beach. Florida
<br />by Horacio Rodriguez
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<br />for Johnson , Avedano , Lopez , Rodriguez & Walewski Engineer; ng Grollp. Tn-r.
<br />whosebusinessaddressis 2510 NW 97th Avenue, Ste 220, Doral, FL 33172
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<br />and (if applicable) its Federal Employer Identification Number (FEIN) is ')q-? 6009 54
<br />(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement:
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<br />2. I understand that a "public entity crime" as defined in Paragraph 287.133(I)(g), Florida Statutes, means a violation of
<br />any state or federal law by a person with respect to and directly related to the transaction of business with any public
<br />entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to,
<br />any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any
<br />other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or
<br />material misrepresentation.
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<br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.I33(1)(b}, Florida Statutes means a finding
<br />of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial
<br />court of record relating to charges brought by indictment or information after July I, 1989, as a,result of a jury verdict,
<br />nonjury trial, or entry of a plea of guilty or nolo contenders.
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<br />4. I understand that an "affiliate" as defined in Paragraph 287. 133 (I)(a), Florida Statutes, means:
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<br />a. A predecessor or successor of a person convicted of a public entity crime; or
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<br />b, An entity under the control of any natural person who is active in the management of the entity and who has been
<br />convicted of a public entity come. The term "affiliate" includes those officers, directors, executives, partners,
<br />shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership
<br />by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income
<br />among persons when not for fair market value under an alm's length agreement, shall be a prima facie case that
<br />one person controls another person, A person who knowingly enters into a joint venture with a person who has
<br />been convicted ora public entity crime in Florida during the preceding 36 months shall be considered an affiliate,
<br />5, I understand that a "person" as defined in Paragraph 287, I33(!)(e), Florida Statutes, means any natural person or entity
<br />organized under the laws of any state or of the United States with the legal power to enter into a binding contract and
<br />which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which
<br />otherwise transacts or applies to transact business with a public entity, The term "person" includes those officers,
<br />directors, executives, part " s holders,. employees, members, and agents who are active in management of any
<br />entity,
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<br />Horacia A. Rodriguez
<br />SIGNA'! RE OF AFFIANT (Printed or Typed Legal Name of Affiant)
<br />(\ , ~ ood.P
<br />State of \-lO~~Otcount)' of m ~ r1\ _' ~
<br />Sworn to and subscribed before me this 2.<.\ day of ~.AU ,2007 by
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<br />Notary's Name Printed, Stamped or Typed
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<br />Personally Known: X or Produced Identification _Identification Produced
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<br />Notary Seal:
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<br />Notary Public State of Florida
<br />Anna Leon
<br />My Commission 00385331
<br />xplres
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<br />Page 80f9
<br />RFQ 07-03-0 I Engineering Srvs Bridge Revised (Addendum I).doc
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