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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 AUTIIORIZED TO ADMI!\IISTER OATHS.
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<br />I. Thisswornstatementissubmittedto City of Sunny Isles I3each
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<br />by __/IiIi'lTIllpl C Vpr,"'l
<br />fur Manuel G Vera & Associates, Inc.
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<br />whose business address is
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<br />13960 SW 47th Street, Miami, FL 33175
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<br />and (if applicable) its Federal Employer Identification Number (FEIN) is ') 9-1 741 hi q
<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. 1 understand that a "public entity crime" as defined in Paragraph 287 .133(1)(g), Florida Statutes, means a violation of
<br />any Wife or federal law by a person with respect to and directly related to the transaction of busir.ess with any public
<br />entity or with an agency or political subdivision of any other state or of the Cnited 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. 1 understand that "convicted" or "conviction" as defined in Paragraph 287. 1 33(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 or state trial
<br />court of record relMinglo charges brought by indictment or information after July I. 1989, as a result of a jury verdict,
<br />nanjury 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. [33(1)(a), Florida Statutes, means:
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<br />a. A predecessor or successor of a person convicted of a public entityerime; 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 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 of a 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(l)(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 />director, executives, partners, shareholders, employees. members, and agents who are active in management of any
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<br />I SIGNATURE OF IANT
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<br />State df (iC:.TiI/1(1Countv of /'r? to ,rl I
<br />Sworn to'and subscribed before me this c.'!-U }-/'l day of 1~(J"1 /
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<br />Manuel G Vera
<br />(Printed or Typed Legal Name of Affiant)
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<br />, 2007 by
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<br />Notary's Name Printed, Stamped or Typed
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<br />Notary Seal:
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<br />6~J~~1~} "",r~:)::~~~ ;.:;;:iE,~,
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<br />. ":;":,:' ~!,: : }~~~{ ..: :;~ ~ Ij~~~. i
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<br />Personally Known:
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<br />or Produced Identification _Identification Produced
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<br />Page 80f9 .
<br />RFQ 07-03-0 I Engineering Srvs Bridge Revised (Addendum. I)
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