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<br />RECEIVED <br /> <br />JUL 1 3 2009"o'.tl <br /> <br /> <br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br /> <br />THIS 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. <br /> <br />This s~~rn statement ~submitted - /1 6 p -- <br />to (~'I\.V\ ~\' ,)U Y\A,d T'S~o~ _,QACl-h.-J <br /> <br /> <br />~:r 1~;fc~~~::i~~~~,if'lo!~ <br /> <br />whose business address is <br />'7 -:+-~ "-') ~ ~ ~ - <br /> <br />~,--{(~ ~ I ~L -:)3 ( d-(D <br /> <br />and (if applicable) its Federal Employer Identification Number (FEIN) <br /> <br />(, ~-O ;;)3'--\ 7 ~. l <br />(lfthe entity had no FEIN, include the Social Security Number of the individual signing <br />this swom statement: <br /> <br />2. I understand that a "public entity crime" as defined in Paragraph 287. I 33(1)(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 />misrepresentation. <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 I, 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(1)(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 tenn "af1iliate" <br />includes those of1icers, directors, executives, partners, shareholders, employees, <br />members, and agents who are active in the management of an af1iliate. 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 />value under an arm's length agreement, shall be a prima facie case that one person <br />controls another person. A person who knowingly enters into a joint venture with a <br />