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SWORN STATEMENT UNDER SECTION 287.133(3)(&) <br />F�Oj2�QA STgTUTS, ON PUBLIC ENTITY CRIMES <br />THI5 FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER <br />AUTHORIZED TO ADMINISTER OATHS. <br />This sworn statement is submitted with Bid, Proposal or COnCI'dCC No. <br />}IZ0i <br />z This sworn statement is submitted by ICIeSJ�1em� Whose business address is ISI <br />and(if applicable )Federa! <br />Employer Identification Number (FEIN) is <br />—� e2S�FloB/ <br />3. My name is �n�tQ <br />vcN and my relationship to <br />the entity named above is <br />understand that a 'Public entity crime', <br />57_-..3(1)(9), Florida r,r as defined in Paragraph <br />federal few b e means a violation of any scare cr <br />y person directly related to the transaction of business <br />-itn a public entity or with an agency or political subdivision of any <br />ocnar state, or with the United States (U:S.) including but not 1imitec <br />to, any bid or contract for goods or services to provided to any public <br />encicy or agency or political subdivision of any other state in the u.5, <br />involving, antitrust, fraud, theft, bribery, collusion, racketeering, <br />conspiracy, or material misrepresentation. <br />understand that "convicted" or 'conviction" as defined in Paragraph <br />133( 1)(b), Florid§_Statutes means a finding of uilt f a public entity crime; with or without an ad•udicationoofcguilt,iin onvicLo <br />any federal or state trial court of record relating to charges brought <br />by indictment or informational after July 1, 1989, as a result of a jury <br />verdict, non -Jury trial, or entry of plea of guilty or nolo contendera. <br />understand that an "affiliate" as defined in Paragraph 287.133(!)(a ), <br />°! o_da_Sta_tu t_e _s means 1 A predecessor or successor of a person <br />convicted of a public entity crime; or 2. An entity under the control <br />cf any natural person who is active in the management Of the entity and <br />::ho has been convicted of a public entity crime. The term "affiliate" <br />includes those officers, directors, executives, partners, shareholders, <br />employees, members and agents who are active in the management of an <br />arri!iate. The ownership <br />P y one person of shares constituting a <br />Controlling interest in another person, or a pooling of equipment or <br />income among persons when not for fair market value under an arm's <br />len9tn agreement, shall be a prima facie case that one <br />anccnar person. A person who knowingly Person controls <br />9 Y enters into a joint venture With <br />a �rrson who has been convicted of a public entity crime in Florida <br />curing the preceding 36 months shall be considered en affiliate. <br />? ! understand that a "Parson" <br />as defined in Paragraph 287d and <br />ri )(r), <br />- !Gda Statutes means any natural person or entit y organized under <br />!aws or any state or of the United Sates with the er the <br />into a binding contract and which bids or applies power to racer <br />Tor the provision of pPlies to bid on contracts <br />goods or services let by a public entity, or ::nicr. <br />ocn =r•.:isa transacts or applies to transact business with a pun,!i,c <br />entity- The term "Person' includes those officers, directors, <br />executives, partners, shareholders, employees, members and agents who <br />are active in management of an entity. <br />Page 7 <br />