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<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
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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 />I. This sworn statement is submitted to City of Sunny Isles Beach
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<br />by
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<br />Luis Olivares, P,E.
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<br />for RFO 07-03-01 Engineering Serv, Bridge
<br />whose business address is 1150 NW 72nd Ave" Suite 350, Miami, FL 33126
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<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 59 -212 8 0 93
<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(1)(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(I)(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 />COUlt 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 pIca 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 "afliliate" 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 arm'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, 1 33(1)(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 transac r lies to transact business with a public entity, The term "person" includes those officers,
<br />director, xecuti ers, s ar ers,' employees, members, and agents who arc active in management of llny
<br />entity, ().
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<br />~ Luis Olivares, P,E,
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<br />(Printed or Typed Legal Name of Affiant)
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<br />, 2007 by
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<br />Notary Seal:
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<br />Notary Public State of Florida
<br />Maria Quinones
<br />My Commission 00619276
<br />E ires 12/22/2010
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<br />Personally Known:
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<br />or Produced Identification
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<br />_Identification Produced
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<br />Page 8 of9
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum 1 ),doc
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