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. . . . . . . . . I- . . . . . . . . . . . . . . . . . . . . . . SWORN STATEi\IENT PURSUANT TO SECTION 2S7.LB(J)(a) FLORIDA STATUTES. ON PUBLIC ENTITY CRIi\II~S THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. I. This swor.",,",,,,,o:,, ;/ ,,,b,,,;,,,,, In -717 Ie e tiy-qj} 5' I/hn y .7S/es l3f'tlC "- by_Iiarl w. 5-1v~r ::":n~!:,S",,-:!:,<;f:;g ~;~ ~~:n~ (](}ro..l Ga hies} FL 33/Y(P AveJ.1f1'f!., 5c//ie. ( 3GO and (if applicable) its Federal Employer Iderllification Number (FEIN) is 5' ~- 08 ! l( 0 (P'1 (IF the entity had 110 FEIN. include the Social Security Number of the individual signing this sworn stalement: 1 I understand that a "public entity crime" as defined in Paragraph 287.I.B(I)(g). Florida Statutes. means a violation of any state or federal law by a person with respecl /() and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States. including. but not limited to. any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust. fraud. theft. bribery. collusion. racketeering. conspiracy. or materialmi.srepresentation. .1. I understand Ihat "convicted" or "conviction" as defined in Paragraph 287. I .1.1( I )(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 court of record relating to charges brought by indictment or information after July I. 1989. as a result of a jury verdict. nonjury trial. or entry of a plea of guilty or nolo contenders. ..L I understand that an "affiliate" as defined in Paragraph 287.1.1.1(1)(a). r:lorida Stallltes. means: a. A predecessor or successor of a person convicted of a publ ic entity crime: or b. An entity under the control of any natural person who is active in the management of the entity ,llld who has been convicted of a public entity come. The term "affiliatc" includes thosc officers. directors. executives. partners. shareholders. employees. mcmbcrs. and agents who are active in the managemcnt of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipn1l:I1t or income among persons when nol for fair market value under an arm's length agreement. shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint vcnture with a person who has been convicted of a public el1tity crime in Florida during the preceding 30 months shall be considered an affiliate. S. I understand that a "person" as defined in Paragraph 287.1 .13(\)(e). Florida Statutes. mcans any natural person or entity organized under the laws of any state or of Ihe Unitcd States with the 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" includes those officers, directors. executives. partners. shareholdcrs. employees. members. and agents who arc active in management of any entity. (Printed or Typed Legal Name of Affiant) State of F/.oltl~ A County of M, AmI - t;:)j:\ i'::> E Sworn to and subscribed bef()re me this ~.2 day of 1'1 A ~ A~__J-~~ ~ .s 4..; ~ ~ · 5 f IU c....E. Notary's Name Printed. Stamped or Typed Personally Known: _L or Produced Identification _ . 2()()7 by Notary Seal: f --~~') A ....1III2OlI7 I '" 1DndId""'~. ...................~~~.~.:.I~J [dellt i ficat ion Produced Page 6 of 7 ()7.().J.O] (jell rll~ SIT~ IInilllge I'k (j(/mge Hid (RJrf/