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Tally Engineering, Inc. #1
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(09-05-01) Threshold Insp. Svcs. for Heritage Park Pkg. Garage
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Tally Engineering, Inc. #1
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Last modified
5/12/2011 10:30:24 AM
Creation date
11/19/2010 3:53:18 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Threshold Insp. Svcs.
Bid No. (xx-xx-xx)
09-05-01
Project Type (Bid, RFP, RFQ)
RFQ
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<br />I. <br /> <br />i I <br />I <br />! I <br />I <br />I <br /> <br />I <br />1 <br />1 <br />1 <br />I <br />I <br />1 <br />I <br />I <br />1 <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) <br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br /> <br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A <br />NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER <br />OATHS. <br /> <br />1. This sworn statement is submitted <br />to e'I+~) C'i-\ SUI-'n~ j =r:,,:> \<''-::> ~(yjl <br /> <br />by "Vlf(Y'''O:-'VJ4'''>''-(){ llr\ \ <br /> <br />for U'-I \ \ \ J E rY:) \ ...~ P \2-\ YlC~ =rcr <br /> <br />whose business address is <br />\C;"-~tol() ~\. ~'c:\vY)'\ (-~.r., r~r\ ~ ~.-~(~ <br /> <br />'Pf"V)l\~.N(')J..O MI'\OS ~(. 5~~C'j7T') <br />, <br /> <br />and (if applicable) its Federal Employer Identification Number (FEIN) <br />Lo~"5- ()~lr]4 \ q, <br />(If the entity had no FEIN, include the Social Security Number of the individual <br />signing this sworn statement: <br /> <br />2. I understand that a "public entity crime" as defined in Section 287.133(1)(g), Florida <br />Statutes, means a violation of any state or federal law by a person with respect to and <br />directly related to the transaction of business with any public entity or with an agency <br />or political subdivision of any other state or of the United States, including, but not <br />limited to, any bid or contract for goods or services to be provided to any public entity <br />or an agency or political subdivision of any other state or of the United States and <br />involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or <br />material misrepresentation. <br /> <br />3. I understand that "convicted" or "conviction" as defmed in Section 287.133(1)(b), <br />Florida Statutes means a fmding of guilt or a conviction of a public entity crime, with <br />or without an adjudication of guilt, in any federal or state trial court of record relating <br />to charges brought by indictment or information after July 1, 1989, as a result of a <br />jury verdict, nonjury trial, or entry of a plea of guilty or nolo contenders. <br /> <br />4. I understand that an "affiliate" as defined in Section 287.133(1)(a), Florida Statutes, <br />means: <br /> <br />a. A predecessor or successor of a person convicted of a public entity crime~ or <br /> <br />b. An entity under the control of any natural person who is active in the <br />management of the entity and who has been convicted of a public entity crime. <br />The term "affiliate" includes those officers, directors, executives, partners, <br />shareholders, employees, members, and agents who are active in the management <br />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 <br />when not for fair market value under an arm's length agreement, shall be a prima <br /> <br />12 <br />
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