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SECTION 00450 — PUBLIC ENTITY CRIMES AFFIDAVIT
<br /> SWORN STATEMENT UNDER SECTION
<br /> 287 . 133 , FLORIDA STATUTES , ON PUBLIC ENTITY CRIMES
<br /> ' THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br /> OFFICER AUTHORIZED TO ADMINISTER OATHS .
<br /> I . This sworn statement is submitted with Project No . 9327 for Oslo Road and 43rd Avenue
<br /> Intersection Improvements ,
<br /> 2 . This sworn statement is submitted by he, *d
<br /> ' whose business address is �q�e
<br /> and ( if applicable ) its Federa Identification No . ( FE IN ) is c59 . If entity has no
<br /> FEIN , include the Social Security Number of the individual signing this sworn statement :
<br /> 3 . My name ise,�R & L) kq9L , and my relationship to the entity named
<br /> above is
<br /> 4 . 1 understand that a " public entity crime" as defined in Paragraph 287 . 133 ( 1 ) ( g ) , Florida
<br /> Statutes , means a violation of any state or federal law by a person with respect to , and directly
<br /> related to , the transaction of business with any public entity or with an agency or political
<br /> subdivision of any other state or with the United States , including , but not limited to , any bid or
<br /> contract for goods or services to be provided to any public entity or an agency or political
<br /> subdivision of any other state or of the United States and involving antitrust , fraud , theft ,
<br /> bribery , collusion , racketeering , conspiracy or material misrepresentations .
<br /> 5 . 1 understand that " convicted " or " conviction " as defined in Paragraph 287 . 133 ( I ) ( b ) , Florida
<br /> Statutes , means a finding of guilt or a conviction of a public entity crime , with or without
<br /> an
<br /> adjudication of guilt, in any federal or state trial court of record relating to charges brought by
<br /> indictment or information after July I , 1989 , as a result of a jury verdict , non -jury trial , or entry
<br /> of
<br /> ' a plea of guilty or nolo contendere .
<br /> 6 . 1 understand that an " affiliate " as defined in Paragraph 287 ..1.33 ( I ) ( a ) , Florida Statutes ,
<br /> means :
<br /> a . A predecessor or successor of a person convicted of a public entity crime ; or
<br /> b . An entity under the control of any natural person who is active in the management of the
<br /> entity and who has been convicted of a public entity crime . The term " affiliate " includes
<br /> those officers , directors , executives , partners , shareholders , employees , members and
<br /> agents who are active in the management of an affiliate . The .Ownership by one person
<br /> of shares constituting a controlling interest in another person , or a pooling of equipment
<br /> or income among persons when not for fair market value under an arm ' s length
<br /> agreement, shall be a prima facie case that one person controls another person . A
<br /> person who knowingly enters into a joint venture vvi h a pel :toon who has been convicted
<br /> of a public entity crime in Florida during the preceding 36 months shall be considered
<br /> an affiliate .
<br /> 7 . 1 understand that a " person " as defined in Paragraph 287 . 133 ( I ) ( e ) , Florida Statutes , means
<br /> any natural person or entity organized under the laws of any state of the United States with the
<br /> ' legal power to enter into a binding contract and which bids or applies to bid on contracts for the
<br /> provision of goods or services let by a public entity, or which otherwise transacts or applies to
<br /> transact business with a public entity . The term " person " includes those officers , directors ,
<br /> executives , partners , shareholders , employees , members and agents who are active in
<br /> management of an entity .
<br /> Public Entity Crimes Affidavit
<br /> 00450 - 1
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