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<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
<br />PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
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<br />1. This sworn statement is submitted
<br />to Crt-'1 a\- ~::>..)..,\'\I... ~s,.if3> DeVoe\"-"
<br />, \
<br />~ r\( ...}f-r.......0+e ::~. .. ",,"'" ""-_~ ~
<br />by .;>...~,~ I';i?~, m ~'i:::llnge,l:1t1 van..! =~ !~
<br />
<br />
<br />for .f \(~c,.:::;;; (\ f\GJ; Gr.,;.--\ (,iJ('~i ('''1 s.: .... i.ti(p\ (~ (C'JI \;:::ji 1dn\.,~ \';:.'1'1 ~ ,"<,;'('V,(L' Ct, t~\\
<br />\ - . ' .) I
<br />j. \"'1. \' r.:; .1-2 v"""......\"'-
<br />whose business address is
<br />,:';:'C6i I{Vl ~81r, ,~titm",~, '-)!;'..Jt4'1 G.-:{t~&~",>, ,Ct ~(n~
<br />
<br />and (if applicable) its Federal Employer Identification Number (FEIN)
<br />5q' '- '24'2 CSS 50
<br />(If the entity had no FEIN, include the Social Security Number of the individual signing this
<br />sworn statement:
<br />
<br />2. I understand that a "public entity crime" as defined in Paragraph 287. 133(l)(g), Florida
<br />Statutes, means a violation of any state or federal law by a person with respect to and directly
<br />related to the transaction of business with any public entity or with an agency or political
<br />subdivision of any other state or of the United States, including, but not limited to, any bid or
<br />contract for goods or services to be provided to any public entity or an agency or political
<br />subdivision of any other state or of the United States and involving antitrust, fraud, theft,
<br />bribery, collusion, racketeering, conspiracy, or material misrepresentation.
<br />
<br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(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
<br />entry of a plea of guilty or nolo contenders.
<br />
<br />4. I understand that an "affiliate" as defined in Paragraph 287 . 133(1)(a), Florida Statutes, means:
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<br />a. A predecessor or successor of a person convicted of a public entity crime; or
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<br />b. 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 come. The term "affiliate" includes
<br />those officers, directors, executives, partners, shareholders, employees, members, and
<br />agents who are active in the management of an affiliate. The ownership by one person of
<br />shares constituting a 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 length agreement,
<br />shall be a prima facie case that one person controls another person. A person who
<br />knowingly enters into a joint venture with a person who has been convicted of a public
<br />entity crime in Florida during the preceding 36 months shall be considered an affiliate.
<br />
<br />Exhibit "A"
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