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' SWORN STATLMENT PURL -L ANT TO SECTION 287.133(3)(a)
<br />L• IWIDA STATUTES- ON PCBI_IC ENTITY CRIMES
<br />klt'SI BE S16',, .f) ANf) SWORN• t ? . _ U O� ti HI.R
<br />' '?i`1 IC:IAL AU7 HORIZE -D TO ADMJNISfLR OA 'l - -
<br />I h:> >� +rn- :> statement a :.ubmincd to
<br />1 or
<br />,.0 -osc hu"incss addres-, i"
<br />,in,J (ifap ?li.abit) its Fedora' f- rnplo.cr• Idcni;'fic .�- ti r� -: (FI IN) _ _ _
<br />(H- the entity had no FEP`, inciudc the Soda' Sc, ;. \tunber of the indi%idual signing, this sworn statement-
<br />understand that a "public cwiry crime" as detvnec t; Paragraph 287.133(1)(g), Florida Statutes, means a violation of
<br />any state or federal lau by a person wid, respect ,c w,c directly related to the transaction of business with any public
<br />entity or with an agency or political subdivision o,, aL y c;her state or of the Unircd States, including, but not limited to,
<br />any bid ar contract for goods or services to be pre% -;d` °d to any public entity or an agency or political subdivision of any
<br />other state or of the Unircd Stares and involvine ZLn.!:rrusT E1aud, theft, bribery, collusion., racketeering, conspiracy, or
<br />matenal misrepresentation.
<br />undeTstand that "convicted" or "conviction" as dxf:.ned in Paragraph 28T 133(l)(b), Florida Statutes means a finding
<br />of guilt or a conviction of a public entity crime, kith or without an adjudication of guilt, in any federal or state trial
<br />court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict,
<br />nonjury trial, or entry of a plea of guilry or nolo contenders.
<br />t I understand that an "affiliate" as defined in Paragr-aph 281.133(lj(a), Florida Statutes, means.
<br />a. A predecessor or successor of a person convicc., of a public entity crime, or
<br />b. An entity under the control of any natural pe:sc- -L, ho is active in the management of the entity and who has been
<br />convicted of a public entity come The te.=, - aff�l,ate- includes those officers, directors, executives, partners,
<br />shareholders, employees, members, and agem� mho are active in the management of an affiliate. The ownership
<br />by one person of shares constituting a cont*od:�-7 g :rTerest in another person, or a pooling of equipment or income
<br />among persons when nor for fair market vai tinder an arm's length agreement, shall be a prima facie case that
<br />one person controls another person_ A person Who knowingly enters into a joint venture with a person who has
<br />been convicted of a public entity crime in Flonda during die preceding 36 months shall be considered an affiliate.
<br />5. I understand that a `person" as defined in Paragaph 28-.133(1)(e), Florida Statutes, means any natural person of entity
<br />organized under the laws of any state or of the L;n:ted States with the legal power to enter into a binding contract and
<br />which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which
<br />otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers,
<br />directors, executives, parmers, shareholders, employees, members, and agents who are active in management of any
<br />entity.
<br />SIGNATURE OF AFFIANT (Printed or Typed Legal Name of Affrant)
<br />1 State of County of
<br />Sworn to and subscribed before me this day of , 2002 by
<br />Notary Seal:
<br />Notary's Name Printed, Stamped or Typed
<br />' Personally Known: or Produced Identification
<br />' Identification Produced
<br />Pace 9 of 10
<br />Manrcipal Conrracr Services Rjq
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