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<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(11)
<br />FLORIDA STA TUTES. 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 Ammann & Whitney Consulting Engineers, p,c.
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<br />foi' RFQ No. 07-03-01 Engineering Consultant for the North Bay Road Pedestrian and Emergency Vehicle Bridge, and
<br />I b. dd . 96 M t St t N Y k NY 10014 the Town Center Observation peck and Boardwalk
<br />W lose usmess a ress IS or on ree, ew or, .
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<br />and {if applicable) its Federal Employer Identification Number (FEIN) is 13-3835527
<br />(IF the entit~' had 110 FEIN, include the Social Security Number of the individual signing this sworn statement:
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<br />2. I undel'stand that a "public entity crime" as defined ill Paragraph 287,133(I)(g), Florida Stalut~s, 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 stilte or of tile United States, including, out not limited to,
<br />any bid or contrllct 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 287.133(l)(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 01' state trial
<br />court of record relating to charges brought by indictment 01' information aftcr July I, 1989, as a.rcsult 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 287.1 33 (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 undcr 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 "am liate" includes those officers, directors, executives, partners,
<br />shareholders. emplo)'ees, members, and agents who arc 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 knDwingly enters intD a joint venture with a person who has
<br />been convicted of a public entity crime hi 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 natmal pel'son 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, partners shareholders, employees, members, and agents ivho arc active in management Df any
<br />entity,
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<br />Christopher Gagnon
<br />(Printed or Typed Legal Name of Affiant)
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<br />SIG ATURE 0 AFF T
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<br />State ofr/.4U ,/nkountYOf ~
<br />Sworn to and subscribed before me this P-day of
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<br />Notary's Name printed,/ed DrTyped
<br />Personally Known: or Produced Identification
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<br />, 2007 by
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<br />Notary Seal:
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<br />_Identification Produced
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<br />Page 8of9
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum l),doc
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