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<br />( <br /> <br />( <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~ NOTARY <br />PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. <br /> <br />1. <br /> <br />This sworn statement is SUbmi~\e. 'E::ea' ..' k <br />to C "bt--Ar ~nn ~ ch } ~lD(" ll': ,. <br /> <br />bY~~~~~ <br />for '. .. 0-. '- 0 go~~hcn tfSabri{ Co.roPj <br />whose business address is '\ .. ~ .. I ~ <br />2i2. ~ uJ B \J r a F 3 '2."2.; if1 Add.f~ <br />~~ Nw \~~/~a\/~C=-~~, ~dMk~5 <br /> <br />and (if applicable) its Federal Employer Identification Number (FEIN) <br />5"?- (CO 713=1 <br />(If the entity had no FEIN. include the Social Security Number of the individ~al signing <br />this sworn statement <br /> <br />2, I understand that a "public entity crime" as defmed in Paragraph 287.133(l)(g), Florida <br />Statutes, means a violation of any state or federal law by a person with r<<'ispect to and <br />directly related to the transaction of business with any public entity or within agency or <br />political subdivision of any other state or of the United States, including, b~ not limited <br />to, any bid or contract for goods or services to be provided to any public:; entity or an <br />agency or political subdivision of any other state or of the United States aDd involving <br />antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material <br />misrepresentation. <br /> <br />3. I understand that "convicted" or '.conviction" as defmed in Paragraph 2:87.133(1)(b), <br />Florida Statutes means a finding of guilt or a conviction of a public entity clime, with or <br />without an adjudication of guilt, in any federal or state trial court of recof'# relating to <br />charges brought by indictment or information after July 1, 1989. as a result of a jury <br />verdict. nonjury trial, or 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, <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 management of <br />the entity and who bas been convicted of a public entity come. The terin "affiliate" <br />includes those officers, directors, executives, partners, shareholders, employeis, members, <br />and agents who are active in the management of an affiliate. The ownership by one person <br />of 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 axm'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 blic <br />entity crime in Florida during the preceding 36 months shall be considered an <br /> <br />