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SECTION 00450 - Public Entity Crimes Affidavit SWORN STATEMENT UNDER SECTION 287 . 133 , FLORIDA STATUTES ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . t 1 . This sworn statement is submitted with Project No . 0378 for 26th Street Bridge Replacement, 2 . This sworn statement is submitted by ' whose business address is and ( if applicable ) its Federal fdehtification o , ( FEIN ) is . If entity has no FEIN , include the Social Security Number of the individual signing this sworn statement: 3 . My name is r � and my relationship to the entity named above is 4 . 1 understand that a " public entity crime" as defined in Paragraph 287 . 133 ( I ) (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 with 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 of the United States and involving antitrust, fraud , theft , bribery , collusion , racketeering , conspiracy or material misrepresentations . 5 . 1 understand that " convicted " or "conviction " as defined in Paragraph 287 . 133 ( I ) (b) , Florida ' Statutes , means a finding of guilt or a conviction of a public entity crime , with or without an adjudication of guilt , in any federal or state trial court of record relating to charges brought by indictment or information after July I , 1989 , as a result of a jury verdict , non-jury trial , or entry of a plea of guilty or nolo contendere . 6 . 1 understand that an " affiliate " as defined in Paragraph 287 . 133 ( l ) (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 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 arm's length ' agreement , shall be a prima facie case that one 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 36 months shall be considered an affiliate . ' 7 . 1 understand that a " person " as defined in Paragraph 287 . 133 ( I ) ( e ) , Florida Statutes , any natural person or entity organized under the laws of any state 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 . ' 00450 - 1 037&00450 - Public Entity Crimes Affidavit F ;\Englneering\Capital Projects\0378-26th Street Bridge10378-26th Street Bridge CONTRACT OOC\0376-00450 - Public Entity Crimes Affidavit.doc Rev. 05101