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<br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
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<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY
<br />PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
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<br />1. This sworn statement is submitted
<br />to CI1'\ r"I~ bONN" -=f-st.---cc; P:>e1\G-H
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<br />by---tL~ M. \ () \=6u {; A. D"1-
<br />for -({.iN V,)( P"NI F: I\. ~ (lJ 50 :r.. 10 l
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<br />whose business address is
<br />,~o ~ ~ \ 4...\:~ C ,\"
<br />rov\\. \1~t.J 0 ~ ~ ttG 11 I Fc. ~ 3 (9 r; T)
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<br />and (if applicable) its Federal Employer Identification Number (FEIN)
<br />S ').- LO~q- b \0...
<br />(If the entity had no FEIN, include the Social Security Number of the individual signing
<br />this sworn statement:
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<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 />misrepresentation.
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<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,
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<br />4. I understand that an "affiliate" as defined in Paragraph 287,133(l)(a), Florida Statutes,
<br />means:
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<br />a. A predecessor or successor of a person convicted of a public entity crime; or
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<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 />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
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