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40 <br />May 25, 1999 <br />4 <br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), <br />FLORIDA STATUTES, ON PUBLIC EN'T'ITY CRIMES <br />a <br />f <br />THIS FORM MUST BE SIGNED AND, SWORN TO IN ME PRESENCE OF A NOTARY PUBLIC OR <br />OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. <br />T. This sworn statement is submitted to <br />a a- ••rec- Co-1r <br />print aanre of the public entity] <br />by vl . t t sr 5 c, . v t, 7t` —4 - <br />print individual's name and title] <br />Li for 5 o Cot -t t-ry r. 4,iz, ryNci =r C, Article 3. <br />THE CON -1 -MCT SUM: The County will pay the Contractor for p formance of the Contract, subject <br />to additions and deductions provided therein, in current funds as follows: <br />li <br />WA Numerical Amount <br />61 Written Amount S _ ' T <br />print name of entity submitting sworn statentcn ] <br />whose business address is- F q 33 S Ty e T3 o V -FL. 374 <br />and (if applicable) its Federal Employer Identification Number (FEIN) is <br />G"- 11kgo-149 <br />If the entity has no FEIN, include the Social Security Number of the individual signing this sworn <br />statement: <br />2. I understand that a "public entity crime" as defined in Paragraph 287.133(l)(g), Florida Statutes, means <br />a violation of any state or federal law by a person with respect to and directly related to the transaction <br />of business with any public entity or with an agency or political subdivision of any other state or of the <br />United States, including, but not limited io, any bili or contract for goods or services to be provided to <br />any public entity or an agency or political subdivision of any other state or of the United States and <br />involving antitrust, Gaud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. <br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(lob), Florida Statutes, <br />means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, <br />in any federal or state trial court of record relating to charges brought by indictment or information after <br />July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contender - <br />4. I understand that an "affiliate" as defined in Paragraph 287.133(t)( a), Florida Statutes, means: <br />PEC -1