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I. I I I I I I I I I I I I I I I I I I SWORN STATEMENT PURSUANT TO SEcrION 287.133(3)(a) FLORIDA STATurES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement iJ. submitted j to "/""A@~ C iyY ~ <:;'U/'1t7 <.# L$("les PROfcj, / by C]a )'0,/1 Lt,' 1/ for ~(jR.QO.U Ue~~s /VA) ITlc. whose business address is 30! NW j 70 slR.e.i'T AJn..aL l'1tCtm j l?et?1c/) 1--[ Z3IC9 / and (if applicable) its Federal Employer Identification Number (FEIN) DID-Iv, SqciLfY (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: 2. I understand that a "public entity crime" as defmed in Section 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or conkact for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud. theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defmed in Section 287.1330)(b), Florida Statutes means a fmding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contenders. 4. I understand that an "affiliate" as defmed in Section 287.133(1)(a), Florida Statutes, means: a. A predecessor or successor of a peISOn convicted of a public entity crime~ or b. An entity under the control of any natural person who is active in the management of the entity and who hu been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another penon, or a pooling of equipment or income among pelSons when not for fair market value under an arm's length agreement, shall be a prima 12