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<br />II <br />II <br />I <br />'I <br />I <br />II <br />II <br />'I <br />II <br />II <br />I <br />I <br />I <br />I <br />I <br />I <br />'I <br />II <br />I <br />'I <br />I <br />I <br />.1 <br /> <br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) <br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br /> <br />TIllS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY <br />PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. <br /> <br />1. This sworn statement is submitted <br /> <br />to ~'\ '1 b CS>~ ~l.t..,,,,> ~---~ ,.{ L.. <br /> <br />by ~~""'.:> \jk~ \......~r <br /> <br />for 7VV\.,^,-\ I-:;.l'-t,S 'P ~-Lf' ~~? uo C>q- D'-1. -6l <br /> <br />whose business address is \ 4'50 \ <-1- C4J~ 'l Uh 't:>r-- ... 'tll""l <br /> <br />~~JJ...r- ~\ ~t \<to <br />j <br />and (if applicable) its Federal Employer Identification Number (FEIN) <br />~ <br />(If the entity had no FEIN, include the Social Security Number of the individual signing <br />this sworn statement: <br /> <br />dJ- l( - /1- sLf '& b <br /> <br />2. I understand that a "public entity crime" as defined in Paragraph 287.133(l)(g), Florida <br />Statutes, means a violation of any state or federal law by a person with respect to and <br />directly related to the transaction of business with any public entity or with an agency or <br />political subdivision of any other state or of the United States, including, but not limited <br />to, any bid or contract for goods or services to be provided to any public entity or an <br />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 <br />mi srepresentation. <br /> <br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(l)(b), <br />Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or <br />without an adjudication of guilt, in any federal or state trial court of record relating to <br />charges brought by indictment or information after July 1, 1989, as a result of a jury <br />verdict, nonjury trial, or entry of a plea of guilty or nolo contenders. <br /> <br />4. I understand that an "affiliate" as defined in Paragraph 287.133(l)(a), Florida Statutes, <br />means: <br /> <br />a. A predecessor or successor of a person convicted of a public entity crime; or <br /> <br />b. An entity under the control of any natural person who is active in the management of <br />the entity and who has been convicted of a public entity come. The term "affiliate" <br />includes those officers, directors, executives, partners, shareholders, employees, <br />members, and agents who are active in the management of an affiliate. The <br />ownership by one person of shares constituting a controlling interest in another <br />person, or a pooling of equipment or income among persons when not for fair market <br /> <br />EXHmIT "A" <br />