HomeMy WebLinkAboutExhibit 7ATTACHMENT 2
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a),
FLORIDA STATUTES, ON PUBLIC ENTITY C RUMS
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICL4L AUTHORIZED TO ADMINISTER OATHS
This sworn statement is submitted to Miami -Dade County
by Joe Arriola, City Manager
(print individual's name and title)
for City of Miami
(print Name of entity submitting sworn statement)
whose business address is 444 S.W. 2nd Avenue, Miami, Florida 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. I 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 Rzth 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. I 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. I understand that an "affiliate" as defined in paragraph 287.133(1)(a), Florida Statutes, means:
1. A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under
the control of any natural person who is active in the management of the entity and whu 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 person who
has been convicted of a public entity crime id Florida during the preceding 36 months shall be
considered an affiliate.
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5. I 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.
6. 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 I (ONE) ABOVE IS FOR THAT PUBLIC
ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR
YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT IAM 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 OFA -NY
CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
(Signature)
01 610 Joe Arriola, City Manager
Sworn to and subscribed before me this day ofcrl 20
Personally known (f '
OR Produced Identification Notary Public- State of rb, L- A �-
My commission expires
(Type of Identification)
OfeI,a E. Perez
(Printed typed or stamped commrssjoned name of notary
Commission#DD221319 public)
;. .4 Expires: Jul 26, 2007
grpoF�pe: Bonded nru
.Atlantic Bonding Co., Inc.
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