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INDIAN RIVER COUNTY - RECREATION MULTI - PURPOSE BUILDING RFP # 6092 SWORN OF SECTION 00650 PUBLIC ENTITY CRIMES STATEMENT SWORN STATEMENT PURSUANT TO SECTION 287 . 133 (3) (A) , FLORIDA STATUTES , ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1 . This sworn statement is submitted with Proposal No. 6092 for South County Park Recreation Multi-Purpose Building. 2. This sworn statement is submitted by PPI Construction Management Inc. (name of entity submitting sworn statement) whose business address is : 3452 Lake Lynda Drive, Suite 400. Orlando, FL 32817 and (if applicable) its Federal Employer Identification Number (FEIN) is 59-3185764. (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement. 3 . My Name is John V. Carlson (please print name of individual signing) and my relationship to the entity named above is President. 4. 1 understand that a "Public Entity Crime" as defined in Paragraph 287 . 133 (1) (g), Florida Statutes, means a violation of any state or federal law by a person with respect to 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 the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. `'tIw►' 5. 1 understand that "convicted" or " conviction" as defined in Paragraph 287 . 133 (1) (b) , Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in federal or state trial court of record relating to charges brought by indictment or information after July, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilt or nolo contendere. 6. I understand that an "affiliate" as defined in Paragraph 287 . 133 (1) (a) , Florida Statutes, means: A. A predecessor or successor of a person convicted of a public entity crime; or B. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The Term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one (1 ) person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arms' length agreement shall be a prima facie case that one (1) person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding thirty-six (36) months shall be considered an affiliate. 7 . I understand that a "person" as defined in Paragraph 287 . 133 (1) (e) , Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter 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 business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 00650- 1 8. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this PPI Construction Management ♦ Ponikvar & Associates 48