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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 /> t 1 . This sworn statement is submitted with Project No . 0378 for 26th Street Bridge <br /> Replacement, <br /> 2 . This sworn statement is submitted by <br /> ' whose business address is <br /> and ( if applicable ) its Federal fdehtification o , ( FEIN ) is . If entity has no <br /> FEIN , include the Social Security Number of the individual signing this sworn statement: <br /> 3 . My name is r � 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 ( I ) (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 of <br /> a plea of guilty or nolo contendere . <br /> 6 . 1 understand that an " affiliate " as defined in Paragraph 287 . 133 ( l ) (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 with a person 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 , <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 /> ' 00450 - 1 037&00450 - Public Entity Crimes Affidavit <br /> F ;\Englneering\Capital Projects\0378-26th Street Bridge10378-26th Street Bridge CONTRACT OOC\0376-00450 - Public Entity Crimes Affidavit.doc Rev. 05101 <br />