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<br />.HY UN.., "UU I!.ll'l1!.N r PURSUANT TO SI!:LTIUN Z1S7. u.Jp)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
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<br />nus fORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE Of A NOTA..RY PU13LlC OR OTHER
<br />OFFICIAL AUTHORIZED TO ADMINISTER OA THS.
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<br />This sworn statement is submitted to Ct~ Of- Sunn'l Isl.e~ Bea.ch by \~c..~y M.Or-hi..
<br />for ~ i..~n5 &l~,.I'V\{ .
<br />whose busmess address is ~ AHonhc. 1\11.
<br />Sunr\LJ..I~, fl., ~;l(t:O .. W"d-(ifapplicable) its
<br />Federal Employer Identification Number (FEIN) is ~ -olqyrl~ the entity had no FEIN, include the Social
<br />Security Numher of the individual signing thIs sworn statement:
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<br />1.
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<br />I understand that a "P1lblic entity crime" as defined in P;lri\graph 287. 133( 1 )(g), Florida Statutes. means a
<br />violation of any state or federal law by a persoll with respect to and directly related to the transaction of business
<br />with any public entity or with an agency or political subdivision of any other state or wtth the United States,
<br />including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or
<br />an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft,
<br />brihery, collusion, racketeenng, conspiracy, (,r material misrepresentatIOn.
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<br />3.
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<br />I understand that "convIcted" or "conviction" as defined in Para. 287.133( 1 )(b), Florida Statutes. means a finding
<br />of guilt or a conviction of a public entity crime, with or without an adjudication of gUilt, in any federal or state
<br />trail court of record relating to charges brought by indictment or information after July I, 1989, as a result of
<br />a Jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere.
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<br />[ understand that an "affil iate" as defined in Para 287. 13 3( I )(a), Florida Statutes, means:
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<br />I. A predecessor or successor of a person convicted of a public entity crime; or
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<br />2 Any entity under the control of any natural person who is active in the management of the entity and
<br />who has been convicted of a public entity crime. Th\:: term "affiliate" mcludes thos\:: officers. directors,
<br />ex:ecutors, partners, shareholders, employees, members. and agents who are active in the management
<br />of an affiliate. The o\\nership by one person of shares constituting a controlling interest in another
<br />person, or a pooling of equipment or income among persons when not for fair market value under an
<br />arm's length agreement, shall be a pnme facie case that one person controls another person. A person
<br />who knowingly enters into a j01l1t venture with a person who has been convicted of a public entity
<br />crime in Florida dunng the preceding 36 months shall be considered an affIliate.
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<br />5 [ understand that a "person" as defined in Para 287.133( Il<.e), Flonda Statutes, means any natural person or
<br />entity organized under the laws ofwy state or of the united States With the legal power to enter into a bmding
<br />Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public
<br />entity. or which otherwise transacts or applies to transact business ....-1th a public entity. The term "persons"
<br />IOcludes those officers, directors. executives, partners. shareholders. employees, members, and agents who are
<br />active in management of any entity
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<br />o. l3ased on lnform!\tion !\l1d belief, the st~tement which 1 have m~k~g b~low is tf\le in r~l!\tion to the entity
<br />submitting this sworn statement. (Indicate which statement applies.)
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<br />V Neither the entity submlttmg this sworn statement, nor any of it's officers, directors, executives.
<br />partners, shareholders, employees, members, or agents who are acti..e 11\ the management of the entity, nor any
<br />atTlliate of the enttty has been charged with and convicted of a public entity crime subsequent to July I, 1989.
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<br />00456 - 2
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