HomeMy WebLinkAboutExhibit 6ATTACHMENT E
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC
OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS
This sworn statement is submitted to Miami -Dade County
by Sergio Torres, Administrator
(Print individual's name and title)
for City of Miami
(Print Name of entity submitting sworn statement)
whose business address is 444 SW 2nd Avenue, Miami, FL 33130
and if applicable its Federal Employer Identification Number (FEIN) is 59-6000375
If the entity has no FEIN, include the Social Security Number of the individual signing
this sworn statement:
2. 1 understand that a "public entity crime" as defined in paragraph 287.133 (1)(g), Florida
Statutes, means a violation of any state or federal law by a person with respect to and
directly related to the transactions of business with any public entity or with an agency or
political subdivision of any other state or with the United States, including, but not limited
to, any bid or contract for goods or services to be provided to public entity or agency or
political subdivision of any other state or of the United States and involving antitrust,
fraud, theft, bribery, collusion, racketeering, conspiracy, or material misinterpretation.
3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133 (1)(b),
Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or
without an adjudication of -guilt, -in any federal or state trial court of record relating to
charges brought by indictment or information after July ,1, 1989, as a result of a jury
verdict, non jury trial, or entry of a plea of guilty or nolo contendere.
4. 1 understand that an "affiliate" as defined in paragraph 287.133(1)(a), Florida Statutes,
means:
A. A predecessor or -successor of a person convicted of a public entity crime; or
B. An entity under the control of any natural person who is active in the
management of the entity and who has been convicted of a public entity
crime
The term "affiliate" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in the
management of an affiliate. The ownership by one person of shares
constituting a controlling interest in another person, or a pooling of equipment
or income among persons when not for fair market value under an arm's
length agreement, shall be a prima. facie case that one person controls
another person. A person who knowingly enters into a joint venture with a
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person who has been convicted of a public entity crime in Florida during the
s
preceding 36 months shall be considered an affiliate.
5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes,
means any natural person or entity organized under the laws of any state or of the
United States within the legal power to enter into a binding contact and which bids or
applies to bid on contracts for the provision of goods or services let by a public entity, or
which otherwise transacts or applies to transact business with a public entity. The term
person" includes those officers, executives, partners, shareholders, employees,
members, and agents who are active in management of an entity.
Based on information and belief, the statement which I have marked below is true in
relation to the entity submitting this sworn statement. (Please indicate which statement
applies.)
X Neither the entity submitting this sworn statement, nor any of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in
the management of the entity, nor any affiliate of the entity has been charged with and
convicted of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in
the management of the entity, nor any affiliate of the entity has been charged with and
convicted of a public entity crime subsequent to July 1, 1989. However, there has been
a subsequent proceeding before a Hearing Officer of the State of Florida, Division of
Administrative Hearings and the Final Order entered by the Hearing Officer determined
that it was not in the public interest to place the entity submitting this sworn statement on
the convicted vendor list. (attach a copy of the final order).
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING
OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH II(ONE)_ ABOVE 1S FOR
THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31
OF THE CALENDAR YEAR IN WHICH IT IS FILED. 1 ALSO UNDERSTAND THAT 1 AM
REQUIRED TO INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT
IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017 FLORIDA
STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFOR�VIATION CONTAINED
IN THIS FORM. j
igN*ure)
Sworn to and subscribed before me this day of ,
20 . Personally known
OR Produced Identification
(Type of Identification)
Notary Public - State of
My commission expires
(Printed typed or stamped commissioned name of notary public)
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