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SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES ON PUBLIC ENTITY CRIMES
<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR
<br />OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br />1 . This sworn statement is submitted to the & N a su nnq 14C6 &.0Q6k
<br />by I I I 5 Y41
<br />for pID,e, 'r--xr1s �Yl iCX QYLS�S,� �Y1C
<br />whose business address is 32�1ClY1-L �y[ihu�
<br />S,u1XUn- Isles &ad,, FL p
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is (P5- 01619TIq _
<br />(IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn
<br />statement:
<br />2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
<br />violation of any state or federal law by a person with respect to and directly related to the transaction of
<br />business with any public entity or with an agency or political subdivision of any other state or of the
<br />United States, including, but not limited to, any bid or contract for goods or services to be provided to any
<br />public entity or an agency or political subdivision of any other state or of the United States and involving
<br />antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
<br />3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes
<br />means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in
<br />any federal or state trial court of record relating to charges brought by indictment or information after July
<br />1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contenders.
<br />4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:
<br />a. A predecessor or successor of a person convicted of a public entity crime; or
<br />b. An entity under the control of any natural person who is active in the management of the entity and
<br />who has been convicted of a public entity come. The term "affiliate" includes those officers,
<br />directors, executives, partners, shareholders, employees, members, and agents who are active in the
<br />management of an affiliate. The ownership by one person of shares constituting a controlling interest
<br />in another person, or a pooling of equipment or income among persons when not for fair market value
<br />under an arm's length agreement, shall be a prima facie case that one person controls another person.
<br />A person who 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 />I understand that a "person" as defined in Paragraph 287.133(l)(e), Florida Statutes, means any natural
<br />person or entity organized under the laws of any state or of the United States with the legal power to enter
<br />into a binding contract and which bids or applies to bid on contracts for the provision of goods or services
<br />let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The
<br />term "person" includes those officers, directors, executives, partners, shareholders, employees, members,
<br />and agents who are active in management of any entity.
<br />q ZC� v2
<br />S gnatur Date
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