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fis <br />STATEMENT OF PUBLIC ENTITY CRIMES <br />This form is a sworn statement Lander Section 287.133(3)(a), L"loAda Ssatnlcs, on public entity <br />cringes 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.-ZQS�L <br />for6o.4tirigRaugt3suldiugs <br />2. This sworn statement is submitted by William Glover, Inc! <br />(name orcot"ry subnuning swan suttrnn 2€16 North Babcock 5t., Melbourne, Florida 32935 <br />whose business address is�_ <br />and applicable) its Federal <br />Employer Identification Number (FEIN) is 59-2300274 . (1f the entity <br />has no FEIN, include the Social Security Number of the individual signing this sworn <br />statement: } <br />3. My naive is William Glover <br />(plow Vnl nanx of individual signing) <br />and my relationship to the entity named above is President <br />4. I understand that a "Public Entity Crime" as defined in Paragraph 287.133(t)(g), Elmida <br />S].aiutcs, 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 or <br />political subdivision of any other State or with the United States, including, but not limited <br />to, any bid or contract for goods or services to be provided to any public entity or an agency <br />or political subdivision of any other state or of the United States and involving antitrust, <br />fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. <br />S. 1 understand that "conNicled" or "conviction" as defined in Paragraph 286.133(1)(b), Florida, <br />Sl,'aodies, means a finding of guilt or a conviction of a public entity crime, with or without an <br />adjudication of guilt, in any Federal or State trial court of record relating to charges brought <br />by indictment or information aflcr July 1, 1989, as a result ofajury verdict, nonjury trial, or <br />entry of a plea of guilty or nolo contendere. <br />b. 1 understand that an "affiliate" as defined in paragraph 287.133(1'y(a),F1xidaStaLu1r-, means: <br />a. A predecessor or successor of a person convicted of a public entity crime; or, <br />b. An entity corder the control of a natural person who is active in the management of <br />trite entity and who has been convicted of a public entity crime. The tern "affiliate„ <br />includes those officers, directors, executives, partners, shareholders, employees, <br />members, and agents who are active in the mana,gernent of an affiliate. The <br />ownership by one person of shares constituting a controlling intcscst in another <br />perwn, or a jwk)fing of equipment or income among txTwn% when not for fair market <br />value urxler aro um's .length agreement, xhall be s prima fide case that one per7an <br />contirots rinollicr pawn. <br />S 4 A Tt ME97 tie P(:DL.K tiJilfM C20d9l <br />% I <br />