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M <br />F <br />STATEMENT OF PUBLIC ENTITY CRIMES <br />This form is a sworn statement under Section 287.133(3)(a), Florida Statutes, on public entity <br />crimes and must be signed in the presence of a notary public or other officer authorized to <br />administer oaths. <br />1. This sworn statement is submitted with Bid No.�_ <br />for Sho-oliog RiAnna - SAMDrk <br />2. This sworn statement is submitted by �'� { i"rl { " �� ti (_�, tt; (_� 1112�; . <br />trema oI enWy wbrmt V sawn "ameM} <br />whose business address isS <br />and applicable) its Federal Employer <br />Identification Number (FEIN) is' 1141A 9' (If the entity has no FEIN, include the <br />Social Security Number of the individual signing this sworn statement: . ) <br />2. My name is 111AC ,'`#L g11:c' <br />(+ke" P" raw",. of KW&W ) <br />a d my relatins ip to I entity named above is�1y t't ��'t &,1141- Our <br />4. 1 understand that a "Public Entity Crime" as defined in Paragraph 287.133(1)(g), Florid <br />Statutes, means a violation of any State or Federal law by a person with respect to and <br />directly related to the transaction of business with any public entity or with any agency <br />or political subdivision of any other State or with the United States, including, but not <br />limited to, any bid or contract for goods or services to be provided to any public entity <br />or an agency or political subdivision of any other state or of Rhe United States and <br />involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material <br />misrepresentation. <br />5. 1 understand that "convicted" or "conviction" as defined in Paragraph 286.133(1)(b), <br />Elorida_Statutes, means a finding of guilt or a conviction of a public entity crime, with or <br />without an adjudication of guilt, in any Federal or State trial court of record relating to <br />charges brought by indictment or information after July 1, 1989, as a result of a jury <br />®edict, n :,;.iu� y trial, ui entry of a plea of guilty or nolo contendere. <br />6. 1 understand that an °affiliate" as defined in Paragraph 287.133(1)(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 a natural person who is active in the management <br />of the entity and who has been convicted of a public entity crime. The term <br />"affiliate" includes those officers, directors, executives, partners, shareholders, <br />employees, members, and agents who are active in the management of an <br />affiliate. The ownership by one person of shares constituting a controlling <br />interest in another person, or a pooling of equipment or income among persons <br />STATEMENT OF PUBLIC ENTITY CRIMES <br />6-1 <br />