2004-103 - Laserfiche WebLink

Home Browse Search

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 , I . This sworn statement is submitted with Project No . 9205 for 4th Street Widening from U . S . 1 to West of Old Dixie 2 . This sworn statement is submitted by whose business address is 126loD SAA1 C) Ild DUL1110, 61 I \1 vpPn_ Qn ' t- 0 (oa and (if applicable ) its Federal Identification No . ( FEIN ) is If entity has no FEIN , include the Social Security Number of the individual signing this sworn statement: 3 . My name is �i0 and my relationship to the entity named above is ;!,71 A 014 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 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 ( I ) (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 (1 ) (e ) , Florida Statutes , means 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 - Public Entity Crimes Affidavit j 00450 - 1 1 \00450 - Public Entity Crimes At�idavit.doc F:\Public Works\Capital Projects\Fourth Street-Old Dixie-US1 \CONTRACT DOCUMENTS