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<br />Sworn Statement Pursuant to Section 287.133(3)(a)
<br />Florida Statues, on Public Entity Crimes
<br />
<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br />
<br />1. This sworn statement is submitted to
<br />
<br />the City of Sunny Isles Beach
<br />Miami-Dade County
<br />Florida
<br />
<br />Eugene J. Delaney
<br />
<br />by
<br />
<br />for Thomas Piotrowski
<br />Principal
<br />H2L2 Architects/Planners, LLC
<br />
<br />whose business address is 4800 North Federal Highway
<br />Suite 8104
<br />Boca Raton, FL 33431
<br />
<br />And (if applicable) its Federal Employer Identification Number (FEIN) is 23-1264904
<br />
<br />(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement
<br />
<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
<br />any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy,
<br />or material misrepresentation.
<br />
<br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133{I){b), Florida Statutes means a finding of
<br />guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of
<br />record relating to charges brought by indictment or information after July 1,1989, as a result of a jury verdict, nonjury
<br />trial, or entry of a plea of guilty or nolo contenders.
<br />
<br />4. I understand that an "affiliate" as defined in Paragraph 287. 133{I)(a), Florida Statutes, means:
<br />
<br />a. A predecessor or successor of a person convicted of a public entity crime; or
<br />
<br />b. An entity under the control of any natural person who is active in the management of the entity and who has
<br />been 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
<br />ownership by one person of shares constituting a controlling interest in another person, or a pooling of
<br />equipment or income among persons when not for fair market value under an arm's length agreement, shall be a
<br />prima facie case that one person controls another person. A person who knowingly enters into a joint venture
<br />with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br />considered an affiliate,
<br />
<br />5. I understand that a "person" as defined in Paragraph 287.133(1){e), Florida Statutes, means any natural person or
<br />entity organized under the laws of any state or of the United States with the legal power to enter into a binding
<br />contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or
<br />which otherwise transacts or applies to transact business with a public entity. The term "person" includes those
<br />officers, directors, executives, partners, shareholders, employees, members, and agents who are active in
<br />management of tit
<br />
<br />
<br />k__.
<br />
<br />Thomas Piotrowski
<br />(Printed or Typed Legal Name of Affiant)
<br />
<br />State of Pennsylvania County of Philadelphia
<br />e thO 24" day of April, 2007 by
<br />
<br />
<br />COMMONWEALTH OF PENNSYLVANIA
<br />NOTARIAL SEAL
<br />EUGENE J, DELANEY, Notary Public
<br />City of Philadelphia, Phila. County
<br />My Commission Expires January 12,2009
<br />
<br />o Identification Produced
<br />
<br />Eugene J
<br />
<br />Notary Seal:
<br />
<br />.H2L2 ARCHITEC TURE. PLANNING. INTERIOR DESIGN. INFRA STRUCTURE H2L2LC
<br />
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