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<br />Attachment D3
<br />
<br />SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a),
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
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<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR
<br />OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS
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<br />1. This sworn statement is submitted to Miami-Dade Countv
<br />
<br />for i)~l
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<br />tJ. _Jilt';,} 1/ i..s leA {jJ PL1 L It.-
<br />(prifit Name of entity submitting sworn statement)
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<br />whose business address is /fi7/t1 LiJI//.ld ,/I/;',,'dc
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<br />by
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<br />and if applicable its Federal Employer Identification Number (FEIN) is ['.!'i- {)1J'-'/Iu~ /
<br />If the entity has no FEIN, include the Social Security Number of the individual signing
<br />this sworn statement:
<br />
<br />2. I understand that a "public entity crime" as defined in paragraph 287.133 (l)(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 />transactions of business with any public entity or with an agency or political subdivision of any other
<br />state or with the United States, including, but not limited to, any bid or contract for goods or services
<br />to be provided to public entity or agency or political subdivision of any other state or of the United
<br />States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material
<br />misinterpretation.
<br />
<br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133 (l)(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 />
<br />4. I understand that an "affiliate" as de:i!led 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 2. An entity under
<br />the control of any natural person who is active in the management of the entity and who has been
<br />convicted of a public entity crime. The term "affiliate" includes those officers, directors,
<br />executives, partners, shareholders, employees, members, and agents who are active in the
<br />. management of an affiliate. The ownership by one person of shares constituting a controlling
<br />interest in another person, or a pooling of equipment or income among persons when not for fair
<br />market value under an arm's length agreement, shall be a prima facie case that one person
<br />controls another person, A person who knowingly enters into a joint venture with a person who
<br />has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br />considered an affiliate.
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