Laserfiche WebLink
PUBLIC ENTITY CRIMES <br /> SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES ON PUBLIC <br /> ENTITY CRIMES <br /> THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR <br /> OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. <br /> 1. This sworn statement is submitted to submitted g CI I OY SU ri1.1 <br /> 1 1 t <br /> SIe <br /> byT�nPRocs <br /> / <br /> for DQYULIIq U-I i11.1-111 Con4-14X-4 ion <br /> whose business address is ('10 Colhvltcct Rd ,115 , ft6y <br /> " rvi &ace\ 1 (IL 3342C, <br /> and (if applicable its Federal Employer Identification Number (FEIN) is <br /> �-01t2oo5 <br /> (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn <br /> statement: <br /> 2 I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, <br /> means a violation of any state or federal law by a person with respect to and directly related to the <br /> transaction of business with any public entity or with an agency or political subdivision of any other <br /> state or of the United States, including, but not limited to, any bid or contract for goods or services <br /> to be provided to any public entity or an agency or political subdivision of any other state or of the <br /> United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or <br /> material misrepresentation. <br /> 3 I understand that "convicted" or "conviction" as defined in Paragraph 283.133(1)(b), Florida <br /> Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an <br /> adjudication of guilt, in any federal or state trial court of record relating to charges brought by <br /> indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a <br /> plea of guilty or nolo contendere. <br /> 4 I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes means: <br /> 1. A predecessor or successor of a person convicted of a public entity crime; or <br /> 2. An entity under the control of any natural person who is active in the management of the <br /> entity and who has been convicted of a public entity crime. The term "affiliate" includes those <br /> officers, directors, executives, partners, shareholders, employees, members, and agents who are <br /> active in the management of an affiliate. The ownership by one person of shares constituting a <br /> controlling interest in another person, or a pooling of equipment or income among persons when <br /> not for fair market value under an arm's length agreement, shall be a prima facie case that one <br /> person controls another person. A person who knowingly enters into a joint venture with a person <br /> who has been convicted of a public entity crime in Florida during the preceding 36 months shall be <br /> considered an affiliate. <br /> 5 I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any <br /> natural person or entity organized under the laws of any state or of the United States with the legal <br /> 00300- 18/26 <br />