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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SWORN STATEMENT PURSUANT TO SECTION 287. UJ(J)(a) FLORIDA STATUTES. ON I'LULlC ENTITY CRIMES THIS FOR\-I MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF 1\ NOTI\RY PUBI.IC OR OTHER OH'ICIAL AUTHORIZED TO ADMINISTER OATHS. I. This sworn statemcnt i~ SUblllitlCd.llJ~\~._Df__5~11~.1'81~_~_G.ouQ...Q. \\cv\QJ':I__~~~-\-~ by (-:1 ~\j DfY\ Yb(\C1.~_.m..... j'(>r ~:!:\Q<(j{))~I_LL~mm.. whose busincs.., address is. '2(,.~A:~::Qr)ill_~.J:L-\e.-~__~7-\\!\Q..<;;'~:l_~CE~ :r L33Qg:(. and (if applicable) its Federal EmploYl'r Idclltificatioll Number (FEIN) is ''"2-0 lar..l:x::J9~ (IF the emily had no FEIN. include lhe Social Security Number ()f the individual signing this sworn slalClllel1l: I u:.dcrstaad thaI a "public cntily crimc" ;1:' defined in P"ragraph 2X7 .IJJ(I)(g), flori0!!.0.J;E\.lrg~. means a vi,)lat ion of any statc or fedcral law by a person with respcct to and directly related to the transaction of business Wilh any public entity or with an agency or political subdivision of any other stale or of the United Stales. including. but not limited 10. any bid or conllact for goods or scrvices to be provided tll any public entity or an agcllcy or political subdivision of any other state or of the United States and involving antitrust. fraud. thdt. bribery, collusion. racketeering. conspiracy. or ll1aterialmisrepresentation. 3. I undelstand that "convicted" or "conviction" as defin<:d in Paragraph 287. I 33(l)(b), Florida Statutes means a finding of guilt or a conviction of a public entity crime. with or without an adjudication of guilt. in any federal or state trial comt of record relating to charg<:s brought by indictment or information after .July I, I 98lJ. a~ a rcsult of a jmy verdict, nonjury trial. or entry of a plea of guilty or nolo contenders. 4. I lInderslancl that an "affiliate" as defined in Paragraph 287.133(1)(a). Florida Statl!!!2. means: a. ;\ predecessor or successor of a person convicted of a puhlic entity crime: or b. An entity under the control of any natural person who is active ill the management of the entity and wl1<1 has becn convicted of a public elltity come. The term "affiliate" includes those officers. direl.tors. e\t'cutivcs. pallners, .\hareholders. employees. members. and agents who arc active in the management of an affiliate. The ownership by olle person of shares constituting a controlling interest in another person. or a pooling of equipment or innHlll' among persons when not for fair market value under an arm's length <lgreemenl. shall be a prima facie l:ase that one person controls another p<:rson. A person who knowingly enters illlo a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133(I)(e). Florida Statutes. means any natural person or entity organized lindeI' the laws of any state or of the United States with the legal power tu enter into a binding contract and which bids or applics to hid on conlracts Ill!' the provision of goods or services let by a public entity, or which otherwise transact~ or applies [0 transact business with a public entity. The term "person" includes those officers. ~,i:,:~"" '::4'" "Z:;;.'''''' 'h'~"', ,,,,piny,,,, """,h,,,,, "'"' "g'"" who "'., '.Cti"e in management of any - ~~- ~~~~g,,~;',;~~~ Stale or.....B~ld&Collnty or2'A\I(\(\.~~ J Sworn to and subscribed bel~)re me this.(~. day of .1:1~{ ___.... 20~)X by ~ ~~()./Y\ ~C' (A~ Wv~ l "';:) ~L~_L~~llit +')~. U ~s...~~ __.._._.. NotalY Seal: Notary's Name Printed, Stamped ,)r Typed Personally Known: __~ .____ or Produced Itklllilicatilln Idelltificllion Produced ~~~~y ~Cl8<r. . . "'c;: " ~? . jJ OF ,,0 Notary Public State of Florida Michelle Saccutelli My Commission 00399359 Expires 02/23/2009 rJ7.().{.1)2 (it'll rllg S,,., IlaiiOgen (il/rugl' Iii" I RI'fl Page 6 of 7