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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SWORN STATEMENT PURSUANT TO SECTION 287.13](3)(a) FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADl'vIINISTER OATHS. I. This sworn statement is submitted to C l~ C~ ~(\(\.'-1 \S\e.s ~ ~ c'O\lT- (' t"",^-Te...r by -v: Mn '\-h,,-,. \-\ . \-\o.a-~:'3 J rp. 'i... for 1\ "-".l"> "'^ ~ HCiC1 ~~ i, A-;:....<I..r>c ''a +e.S J 1 Yl.C . whose business address is f-..nO 1(')L,....h"\&'^ ~r L~^e. ?-.cr,rt, SU~1-f" Ian 1)\u~ ~~ fA jC,L./7? and (if applicable) its Federal Employer Identification Number (FEIN) is 2.~' 2..16toL..I(1) (IF the entity had no FEIN. include the Social Security Number of the individual signing this sworn statement: I understand that a "public entity crimc" as dcfined in Paragraph 287.I3J(I)(g). Florida Statutes. means a violation of :IIlY state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agcncy or political subdivision of any other state or of the United States, including. but not limited to. any bid or contract for goods or serviccs to bc provided to any public entity or an agency or political subdivision of any other state or of thc United States and involving antitrust. fraud. theft. bribcry. collusion. racketeering. conspiracy. or material misrepresentation. I understand that "convictcd" or "conviction" as defined in Paragraph 287.1 JJ(I)(b). Florida Statutes mcans a finding of guilt or a conviction of a public entity crimc. with or without an adjudication of guilt, in any fedcral or statc trial court of record relating to charges brought by indictment or information after July I. 1989. as a rcsull of a jury vcrdict. nonjury trial. or entry of a plea of guilty or nolo contendcrs. 4. I understand that an "affiliatc" as defined in Paragraph 287.133(1 )(a). Florida Statutes. mcans: ') J. a. A predecessor or successor of a person convicted of a public entity crimc: or b. An cntity under the control of any natural pcrson who is active in the managcmcnt of the cntity and who has bcen convicted of a public cntity comc. The term "aftiliate" includes thosc officers. directors. executives. partners. shareholdcrs. employees, mcmbcrs, ami agents who are active in thc management of an affiliate. Thc owncrship by one person of sharcs constituting a controlling interest in anothcr pcrson. or a pooling of cquipmcnt or incomc among persons when not for fair market value under an arm's Icngth agreement. shall be a prima facie case that one person controls another person. A person who knowingly cnters into a joint vcnture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an aftiliate. 5. I understand that a "person" as defined in Paragraph 287.13J(I)(e). Florida Statutes. means any natural person or entity organized under the laws of any state or of the United States with thc legal power to entcr into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity. or which otherwise transacts or applies to transact busincss with a public entity. The term "person" includcs those ofticers. ~Ii~ e~xecutiv/partlnl~'ehOI~S' employccs. mcmbcrs. and agents who are activc in management of any ,// d~ y / I~ -rr~C)'\-V\'1 \-\. H~~~, 'P. ~ . SIGNA F AFFIANT (Printed or Typed Legal Name of Affiant) State of PH County of I) Ie r) 1 (':f .>tt.,,- L I Sworn to and subscribed before me this ol4 (~1Y ot ')'\A.Ld .2007by ~ t-A.o~ '1 H. Hat1 (,,5; P. 't. il~I~CLS ,) K,\J{')<. Notary's Name Printcd. Stamped or Typed l- / or Produced Idcntification Notary Scal: Pcrsonally Known: Identification Prodll\:ed COMMON :TH OF PENNSYLVANIA NOTARIAL SEAL FRANCES P. KNOX, Notary Public Whltpaln Twp., Montgomery County Convnission Expires Janu 8. 2011 07.0./-02 C;('II rllg Sin IIN;lagl' I'k C;nrag(' llid IRJitI Page 6 of 7