Laserfiche WebLink
SWORN STATEMENT UNDER SECTION 287.133(3)(a) <br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br />STATE OF <br />COUNTY OF <br />Polk <br />(To be signed in the <br />presence of a notary <br />public or other officer <br />authorized to administer <br />oaths.) <br />Before me, the undersigned authority, personally appeared Jason T. chambers <br />who, being by me first duly sworn, made the following statement: <br />1. The business address of Tri -Sure Corporation <br />(nameofBidderor Contmctor)is P. <br />0. Box 653 AuhurodaLa.-E1-33A23-- <br />2. My relationship to Tri -sure Corporacion <br />(name of Bidder or Contractor) is Vice President <br />(relationship, such as sole proprietor, partner, president, vice president). <br />3. I understand that a public entity crime as defined in Section 287.133 of <br />Florida Statutes includes a violation of any state or federal law by a person with respect to and <br />directly related to die transaction of business with any public entity in Florida or with an agency <br />or political subdivision of any other state or with the United States, including, but not limited to, <br />any Bid or Contract for goods or services to be provided to any public entity or such an agency <br />or political subdivision and involving antitrust, fraud, theft, bribery, collusion, racketeering, <br />conspiracy, or material misrepresentation. <br />4. 1 understand that "convicted" or "conviction" is defined by the statute to <br />mean a finding of guilt or a conviction of a public entity crime, with or without an adjudication <br />of guilt, in any federal or state trial court of record relating to charges brought by indictment or <br />information after July 1, 1989, as a result of a juryverdict, nonjury vial, or entry of a plea of <br />guilty or nolo contendere. <br />5. 1 understand that "affiliate" is defined by the statute to mean (1) a <br />predecessor or successor of a person or a corporation convicted of a public entity crime, or (2) <br />- an entity under the control of any natural person who is active in the management of the entity <br />and who has been convicted of a public entity crime, or (3) those officers, directors, executives, <br />partners, shareholders, employes, members, and agents who are active in the management of an <br />affiliate, or (4) a person or corporation who knowingly entered into ajoint venture with a person - <br />who has been convicted ofa public entity crime in Florida during the preceding 36 months. <br />L <br />00310-9 <br />