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0 <br />F-1 <br />5111N STATEMENT UNDER SECTION <br />FLORIDA STATUTES ON PUBLIC ENTITY CRIMES <br />TFlXS FORK MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC <br />Oft OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. <br />1. This sworn statement is submitted with Bid, Pre caal or <br />Contract No._ <br />2. This sworn statement is submitted 6y <br />znC, <br />whose business addreouu isr3 ��0z <br />i� ,6 <br />�"'`— and {if a iicaole) its Federal <br />�1{'7 (q , If entity has <br />identification No. (FEIN) is � <br />no FEIN,include the Social Security Number o£ the individual <br />dioning this sworn statement: <br />Ram® e y ��1f�Y�l�JV and my <br />3. My i <br />to the entity named above is <br />relaticnsh <br />f /1-ni 11 h' <br />$, 1 understand that a 'PuQli entityFlorida rime" as defined i <br />me n6 s <br />Paragraph 287,133 (1)(9), <br />violation of any state or federal law by a person with <br />respect to, and directly related to, the transaction of <br />business with any public entity or with an agency or <br />other <br />Political, subrSivision of but <br />not any <br />imited to,any bid or honccontract <br />Political,states, <br />including, <br />any <br />for <br />gaols or <br />political subdivisionices to be of o any other public <br />state entity <br />or of <br />an agency or <br />the United Stota,tssand involving antitrvat, fraud, theft, <br />bribery, c011uxsicnI racketeering, conspiracy or material <br />misrepresentations. <br />5. I understand that B7 133 { 1) {ta 1 to Florida "conviction" <br />nStatutes, asmeansdefined a <br />in Ppragrap <br />finding of guilt Or a conviction of a public entity crime, <br />with or without an. adjudication -Of guilt, in any federal or <br />state tri.al-court of record relating to changes brought -by <br />i»dictmeat•orafasmationr�fter July 1. 1989, as a reeult of <br />a jury -verdict'. non -jury Crial,,,or entry of a plea Of guilty <br />or nolo ccnt¢ndere. ,, <br />b, I under etand-thataanLaaffLJLAte* am defined in Paragraph <br />2B7.133{1}(a)r <br />&. A predecessor or successor of a person convicted <br />of a public entity crimel Or <br />b, An entity under the control of any natural person <br />who is active {.n the management of the entity and <br />who has been convicted of a public entity crime. <br />the term ^affiliate" includes those officers, <br />directors, executives, partnere, shareholdere, <br />