Public Entities Crime AffidavitPUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST
L08BYING SERVICE]
The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State
Statutes. BIDDERS must disclose with their Bids, the name of any officer, director, partner,
associate or agent who is also an officer or employee of the City of South Miami or it's
agencies.
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and (if applicable) its Federal Employer Identification Number (FEIN) is CILL51�?Lll I
(If the entity has no FEIN, include the Social Security Number of the individual signing this
sworn statement;
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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 transaction of business with any public entity or with an agency
or political subdivision of any other state or of the United States, including, but not
limited to , any bid or contract for goods or services to be provided to any public entity
or an agency or political subdivision of any other state or of the United States and
involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material
misrepresentation.
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 I, 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 any 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 in Florida during the 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 with the legal power to enter into a binding contract and which bids or
applies to bid on contracts for the provision of goods or services led by a public entity,
or which otherwise transacts or applies to transact business with a public entity. The
term "person" includes those officers, directors, 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. [Indicate which statement
applies.]
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The entity subm i g hi r I I
directors, e�xecutives, partners, shareholders, employees, membeit, or agents who are
and convicted of a public entity crime subsequent to July I i 1989.
[signature]
Sworn to and subscribed before me this day of 20
Notary Public— State of
My commission expires � /3,
(Printed, typed or stamped commissioned name of notary public)
Form PUR 7068 (Rev.06/11192)
5 -/"3
2013
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