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<br />SWORN STATEMENT PURSUANT TO 51:CT70N 287.133(3)(a)
<br />F LOMA STATUTES, on PU B LTC IENMTY CRIMES
<br />PLIBLJC 1 NTFIry CRIM E s
<br />�W`SW5r1l 10 4'se pronns.r�r� �I I�rugr�pfa �3} ��� �f ;fcl;pn $�7.13,'�. f Iorld,4 S[�1� SCrFIUI�� '� ��'� or a�fil�r�
<br />wria rwa t:ccn placed an tha OrrWt-od Kw4or Irs t Totkawirip a i'wvictko n [pr p pubic an ISIy arirw may not s u basil x
<br />Bld on a CorVxoGt In prmAdn any !;ond-; or &VVICL-s to i� pPuhtc er,tiiy. m)k not auhmit a Sid on a Crjr+dzC[ with a
<br />pubrc entity fu di -L mire ruc3on rr repair of in ptvb be bu.ld.irrg ar pubric Wcfk, n,ay not subrril Bids m S -=+es of
<br />rem pr7,lc-r+.+ Da a pbtc entity, =j not be arxardcd 10 perform Work as a CQrttraVorr. suppbcr, SUI;3 or`jm=, chr
<br />r.Dr=dl-,vit u-mder a ConVart with �irryr pvVw- rantty, .and m2y rel tmmsao b�nwvrws mth jriyr muh-lir. enrty sn oxce-Z
<br />Crf lhu 117rvzixild Hm aurid Ci�Ieip y Two of See, 287.01 F, FS f6t1hlrtyr +Sir manlhti Brom i#hLt- d, -qt-! of boinq placyd an
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<br />THIS FORM MUSLf D E SIG NED AN p SWOR N TO IN 'rH E PRESENCE OF A NOTAR Y PUB LIC OR 0TH 1�k
<br />0+-FbML AUTHOR 2 ED TO A DLIJN rSTER OATHS
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<br />and (rif app1 ) It9 K edcral Ln &ypr 14�ent ization rtiimbor 1I-Fitj i 7 4 7-3 75 41 _
<br />(11 Me en* twkd ron WEF-1. lritkA:Itr Lhc Srr-al Se acini NLffrbr i)f the IndvAdual sgnirk) Otis --,-Lw"
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<br />112. 1 uWarmland IN -it in `putAe enftTy onrnuo" a5 dellrrcd m Parugr M 297,133 %ft. Fb+m4 StNtu�rg. n%g"ns a
<br />V101obw of -any st%m or fecl al Lrrr by n peman wirh res" TD and doc Vly mlaled to the VwWackloo of
<br />Mix= will~; any putic en.i IT or wi-h an .vXncy or poh#Gal sijbdJ won or any car r,.r� ne wuF m Lhe
<br />Unhad St -311m, aldglding, but rwi 16rniled lo, vitt' Bid or lora ma fir !pods or srroce!s 1!1 bo provided 10 any
<br />pubfm-- entity qr an uhf or poC�r s-ubd!Jvin bm C� any atter state jDf Ite Uni!ed qtr, and uivralwfng
<br />Dry mak. Fraud, twrt, Grp', mks, om plrehcy, or rr16al r m{arcprcffoenlal inn.
<br />11.11 I urwspcamrrd lh='carrwr nw- or 'oarr�rf lion w. Ga inad as Para, n?. i 3-,4i xia�. rk nea Swum s- m6ans a
<br />finding of DuAl of a Ct?mvkC60in of a p+ublc emty crow. with or wfthout an ordjudeaLKm PT gdjA In ar+yr
<br />feral w sUla ball COMA of raced rclpkimp to -Choi gr_. bvftghl by indlcimiient or Ini'm"atlan afv r ,July 1,
<br />1989. W a rcmft nt a Jury verd1ci non -jury Dial, or envy of zi oft of gullt} err nalo mridL-ndr: re
<br />71.4. 1 undmtarrd mat an "afflk-Cn` a� rni%eJ a1 PAra, 2157.1.'(l X -a �. F ki ida S=Ds, mearts,
<br />rs, � pmdacessar or mwce sw of u puneo + convived of a public onbty+ crlrm,, or
<br />hx, Myr at" urrdcr vv c,orwvi of any nvurai permn wro cr aawty ■i aw i rwriiagcniero a vice e"
<br />L)rHJ who k1ur batpn CarivItled al n pubk enrityr ffme_ The larm '-1=gTp" inn r_-, T aTI.M-5,
<br />dlMC1nrs: exea rte, pannets, shoar&boildr;m, ftrrtiplrjA=_ mumbera, arld aqerLM whD are acM b
<br />Lhkr m"+m-r-remixil of an -o1Trw;c. The a mcmup try one !pati on bT sha= cava ,tlrxg a c❑ntrull'ing
<br />inri,1031 Ori an tNut puna_ or a pvaia rg or eqrL.Kpment br ixorrw• arrr€Irwj yLiNrits when no[ $or diet
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