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<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
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<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 />
<br />L This sworn statement is submitted to ~t"r y O~" )t!/\//1JY ht...7i)?, -/J/[4..C1-! /
<br />LI D rJ _ [print~e_ofthe public entity]
<br />by cifc.ro/Z LL ~JZ::J /0 ~/o6A/r
<br />[print individual's naJ:)1e nd title] r/
<br />for of2!:,li-pow, iL J.../iL-, 'e:
<br />[print name of entity submitting sw rn statement]
<br />
<br />whose business address is
<br />
<br />G/O,-5 h/, ZD At/I!.,
<br />Mm/V1J-f hi c110J'-!
<br />/
<br />and (if applicable) its Federal Employer Identification Number (FEIN) is 69 - 2...suz z z' /
<br />(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
<br />statement: .)
<br />
<br />2.
<br />
<br />I 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 United
<br />States, including, but not limited to, any bid or contract for goods or services to be provided to any public
<br />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 />
<br />3.
<br />
<br />I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1 )(b), Florida Statues,
<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 contendere.
<br />
<br />4.
<br />
<br />I understand that an "affiliate" as defined in Paragraph 287.l33(1)(a), Florida Statutes, means:
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<br />I. A predecessor or successor of a person convicted of a public entity crime; or
<br />2. An entity under the control of any natural person who is active in the management of the entity and who
<br />has been convicted of a public entity crime. The term "affiliate" includes those officers, directors,
<br />executives, partners, shareholders, employees, members, and agents who are active in the management of
<br />an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or
<br />a pooling of equipment or income among persons when not for fair market value under an arm's length
<br />agreement, shall be a prima facie case that one person controls another person. A person who knowingly
<br />enters into a joint venture with a person who has been convicted of a public entity crime in Florida during
<br />the preceding 36 months shall be considered an affiliate.
<br />
<br />5.
<br />
<br />I understand that a "person" as defined in Paragraph 287,133(1)(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 an entity.
<br />
<br />Form PUR 7068 (Rev, 06/11/92)
<br />
<br />00402-1
<br />
<br />03-417 4
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