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C-1 <br />STATEMENT OF F'l1gL.IC ENTITY CRIMES <br />This form is a swom statement under Section 287.133(3)(x), Florida 51atUQs, on public <br />entity crimes and must be signed in the presence of a notary public or ather offic-er <br />auttlorized to administer oaths. <br />1. This sworn statement is submitted with Bid No. Z[ -D <br />for Bound Island Oce. nfln3 Par <br />2. This sworn statement is submitted by <,u <br />;tvxne o1 errtily <br />st6mXtkv swan alerwA) <br />whose business address is l 4 h F3k� A%1 <br />32--I kq and applicable) its Federal <br />Employer Identification Number (FEIN) is —02901-141 . (If the entity has <br />no FEIN, include the Social Security Number of the individual signing this swam <br />statement. ) <br />2. My name is <br />(piceae ptita Mama of ind VkSUW svft) <br />and my relationship to the entity named above is Pre *— <br />4. 1 understand that a "Public Entity Crime" as defined in Paragraph 287.133(l)(g), <br />Floridaa talutes, means a violation of any State or Federal law by a person with <br />respect to and directly related to the transaction of business with any public entity <br />or with any agency or political subdivision of any other State or with the United <br />States, including, but not limited to, any bid or contract for goods or services to be <br />provided to any public entity or an agency or political subdivision of any other state <br />or of the United States and involving antitrust, fraud, theft, bribery, collusion, <br />racketeering, conspiracy, or material misrepresentation. <br />5. 1 understand that "convicted" or"conviction" as defined in Paragraph 286.133(1 )(b), <br />Florida Statutes, means a finding of guilt or a conviction of a public entity crime, <br />with or without an adjudication of guilt, in any Federal or State trial cotirt of record <br />relating to charges brought by indictment or information after July 1, 1989, as a <br />result of a jury verdict, nonjury trial, or entry of a plea of guilty or nota contendere. <br />6. 1 understand that an "affiliate" as defined in Paragraph 287.133(`6)(a),FJ.B <br />Statu , means: <br />a. A predecessor or successor of a person convicted of a public entity crime; <br />or, <br />b. An entity under the control of a natural person who is active in the <br />management of the entity and who has been convicted of a public entity <br />crime. The term "affiliate" includes those officers, directors, executives, <br />partners, shareholders, employees, members, and agents who are active in <br />STATaffi—M ' aT PUBLIC ITrrrr Y CRAIES <br />S-9 <br />