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' SWORN STATEMENT UNDER SECTION 287 . 133 (3 ) ( a)) O FLORIDA STATUTES ,
<br /> ON PUBLIC ENTITY CRIMES
<br /> ' (To be signed in the presence of a notary public or other officer authorized to administer oaths .
<br /> STATE OF Florida
<br /> ' COUNTYOF Duval
<br /> ' Before me, the undersigned authority, personally appeared Jonathan Belloit who
<br /> being by me first duly sworn , made the following statement:
<br /> The business address of WPC Industrial Contractors Ltd .
<br /> (name of Bidder or Contractor) is 11651 Phillips Hwy . , Jacksonville , FL 32256
<br /> 2 . My relationship to WPC Industrial Contractors , Ltd
<br /> ' (name of Bidder or Contractor) is President of the General Partner
<br /> - (relationship , such as sole proprietor, partner, president, vice president) .
<br /> ' 3 . I understand that aublic entity crime P y e as defined in Section 287 . 133 of Florida
<br /> Statutes includes a violation of any state or federal law by a person with respect to and directly related to
<br /> the transaction of business with any public entity in Florida or with an agency or political subdivision of
<br /> any other state or with the United States , including , but not limited to, any Bid or Contract for goods or
<br /> services to be provided to any public entity or such an agency or political subdivision and involving
<br /> ' antitrust , fraud , theft, bribery, collusion , racketeering, conspiracy, or material misrepresentation .
<br /> 4 . I understand that "convicted " or "conviction " is defined by the statute to mean a
<br /> finding of guilt or a conviction of a public entity crime , with or without an adjudication of guilt, in any
<br /> ' federal or state trial court of record relating to charges brought by indictment or information after July 1 ,
<br /> 1989 , as a result of a jury verdict, nonjury trial , or entry of a plea of guilty or nolo contendere .
<br /> ' 5 . I understand that " affiliate " is defined by the statute to mean ( 1 ) a predecessor or
<br /> successor of a person or a corporation convicted of a public entity crime , or (2 ) an entity under the control
<br /> of any natural person who is active in the management of the entity and who has been convicted of a public
<br /> ' entity crime, or (3 ) those officers , directors , executives , partners , shareholders , employees , members, and
<br /> agents who are active in the management of an affiliate, or (4) a person or corporation who knowingly
<br /> entered into a joint venture with a person who has been convicted of a public entity crime in Florida during
<br /> ' the preceding 36 months .
<br /> 6 . Neither the Bidder or Contractor nor any officer, director, executive, partner,
<br /> ' shareholder, employee , member or agent who is active in the management of the Bidder or Contractor nor
<br /> any affiliate of the Bidder or Contractor has been convicted of a public entity crime subsequent to July 1 ,
<br /> 1989 .
<br /> (Draw a line through Paragraph 6 if Paragra>of
<br /> applies)
<br /> 7 . There�s' en a cf a public e ' c ' me by the Bidder or Contr r,
<br /> ' or an officer, director, teG'"ive , partner, shem ees , member or agent of the Bid or
<br /> Contractor who is ac�five in the managementer or Contractor or an affiliate o� e Bidder or
<br /> I Contractor. determination has been madeo Section 287 . 133 ( 3 ) by ord of the Division of
<br /> Ad rative Hearings that it is not in the . est for the name of the co victed person or affiliate
<br /> ' 044572000
<br /> 00310 (A1 ) - 12
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