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r <br />0 <br />May 25, 1999 <br />SWORN STATEMENT PURSUANT TO SECTION 287,133(3)(a), <br />FLORIDA STATUfU, ON PUBLIC ENTITY CRIMES <br />THIS FORM MUST BE SIGNED AND SWORN i'O IN THE PRESENCE OF A NOTARY PUBLIC OR <br />OTHER OFFICIAL. AUTHORIZED TO ADMINISTER OATHS. <br />L This sworn statement is submitted to / <br />(print name of the public entity] -- _ <br />jprint individual's name and title] <br />for _ �. �'v t r u I. i I ` 1. ° w -i . L-- -t- r� I . Article 3, <br />T14E CONTRACT SUM: The County will pay the Contractor for p ormance of the Contract, subject <br />to additions and deductions provided therein, in current funds as follows: <br />Numerical Amount 4 'I t <br />Written Amount <br />�, ,.] V h.� _ 4- C_ r. } 1- .0 S �!_ ? _....iiY 'ti•`"` x� Y s N <br />]prim name of entity subiniiting swore statestteli ] <br />whose business address isa <br />T' <br />and (if applicable) its Federal Employer IdentiTicatiton Number (FEIN) is <br />0 49 <br />(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn <br />statement: <br />2, <br />!understand that a "public entity crime" as defincd in Paragraph 287.133(I)(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 to, any bid or contract ror goods or services to be provided to <br />any public entity or an agency or political subdivision Of any ollscr state or of the United Stales and <br />involving antitrust, fraud, theft, 'bribery, collision, racketeering, conspiracy, or material misrepresentation. <br />3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(l ()b), _F-loridsr �tattttes, <br />means a funding of guilt or a conviction of,,l 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 ajury verdict, nonjury trial, or entry of a plea of guilty or nolo con,crtdem, <br />4• I understand that an "affiliate" as defined in Paragraph 287,133(1)(a), Florida Statutes, ntcans: <br />PEC -1 <br />