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<br />SWORN STA'I'EWENT PVllStJANT TO SECTION 287. 133(3)(a)
<br />PLOaJDA STATt1I'ES, ONPUBUC llNT1TY CIt1MES
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<br />nus FoRM MUST BE SIONED AND SWORN TO IN mE PRESENCE OF A NOTAllY PUBUC OR. OTHER.
<br />omcw. AUTHOlUZED 1'0 ADMINJS'IEll OATHS.
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<br />This sworn sw.ment is submitted toCITY OF Sm:; t.'. .~_lS:I~~iJ,,'f",,;
<br />wbosebuaiaessaddnsaisl0331 ~J~.T.~~.FL 33777
<br />, " ' , ,', "... (if9PJiClble) iu
<br />FtderIl Empro,.ldeati6:ation Number (FEIN).' - ,,'," ..) ~.. ,', . , ,W Ilc. ......SociaI
<br />Security NuDiber of the individuallianiq dais awoml1llemtnt FBIn" -1683519 ,. '
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<br />1.
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<br />,; '2.-
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<br />';i.~lhatl~tsGcllDtiti;~e.lIS.~ 'bi"~28i13,(iijj,:,,~~~ '~"" ~
<br />viollt:ioaolaay...orfeclelaJlawt.y a~.~to_~"".""~.ot.....
<br />"'WidlIll)',pUWiCltidlY;w_tl.~.ii~~~~~1~~{~;~~~'tfl?~>~~'~j~.,,',,<'
<br />inc1udiaa. but DOt 1imitecl to. Illy Bid or Contact for jOodI' or 1aVi_ to bepnMdecl to 11I1 puWic eatity or
<br />III aa-cy or politicalsubdiviaioa of aay odMr state of the UBi.. SadellIICI iPoIviDa IIdi1rust, hod. 1beft.
<br />bn"bery, coIlUliOD.'~ conspiftlcy,or IIIIfIriaI ~oa.
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<br />3.
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<br />I UDderstand that -convictedB or -cOnviction- IS defined in Para. 287.133(1 )(b). Florida Statutes. I!leIDI a 6ndina
<br />of pitt or -conviction of_public entity crime. with or without aa a4judicatioa of suitt. in uy f'ederal or state
<br />trail court of ~rd reJatiD, to c1waes brouaht by indicbDeDt or infoJmation after 1uly 1. 1989, IS a result of
<br />· jUl)' v.dict. nOD-jwy trial. or en1ry of _ pl. of guilty or nolo CODteDden.
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<br />4.
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<br />I unders1and that an -aftiliateR IS defined in Para. 287.133(1 )(a). Florida S1atutes.. means:
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<br />1. A preclecessor or successor of _ person convicted of a public entity crime; or
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<br />2. Any entity under the CODtrol of any natural person who is active in the lDIDIIemeot of the entity and
<br />who bas been convicted of a public entity crime. The term "affiliate" includes those officers, cIUecton,
<br />executors. partners, shareholders, employees, members, and apnts who are active in the maaaaement
<br />of an affiliate. The ownership by one person of shares constituting. 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 asreement. shall be a prime &cie case that one person coDtrols another person. A person
<br />who knowingly enters into a joint venture with a person who has been convicted of a public entity
<br />crime in Florida during the preceding 36 months shall be considered an afIi1iate.
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<br />S. I understand that a Rperson_ IS defined in Para. 287.133(1 )(e), Florida S1atutes, means any aaturaI person or
<br />entity orpnized under the laws of any state or of the United States with the lepl power to eater into a binding
<br />Contract and which Bids or applies to Bid on ContracU for the provision of goods or services let by a public
<br />entity, or which otherwise transacts or applies to transact business with a public entity. The term -personsR
<br />includes those ofticers, directors, executives, par1nen, shareholders, employees, members, and aaents who are
<br />active in lDlID8gement of any entity.
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<br />6. Based on information and belief: the statement which I have marked below is true in relation to the entity
<br />submitting this sworn statement (Indicate which statement applies.)
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<br />X Neither the entity submitting this sworn statement. nor any of it's officers, directon, executives,
<br />partners. shareholders, employees, members, or agents who are active in the management of the entity, nor any
<br />affilillte of the entity has been charged with and convicted ola public entity crime subsequent to July 1. 1989.
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