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SWORN STATEMENT UNDER SECTION 287,133 (3) (n), FLORIDA STATUTES ON <br /> PUBLIC ENTITY CRIMES <br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER <br /> OFFICER AUTHORIZED TO ADMINISTER OATHS. <br /> 1 . This sworn statement is submitted with Bid, Proposal or Contract No . 6080 for <br /> INDIAN RIVER COUNTY <br /> This sworn statement is submitted by E . J . B REN EMAN L . P . whose <br /> business address is 1117 SNYDER ROAD , WEST LAWN , PA 19609 and (if applicable) <br /> its Federal Identification No . (FEIN) is 234430672 . If entity has no FEIN, include <br /> the Social Security Number of the individual signing this sworn statement: <br /> 3 . My name is PHILIP D . WAGNER and my relationship to the entity <br /> named above is PARTNER <br /> 4 . I understand that a "public entity crime" as defined in Paragraph 287 .I33 ( 1 )(g) , Florida <br /> Statutes , means a violation of any state or federal law by a person with respect to, and directly <br /> related to , the transaction of business with any public entity or with an agency or political <br /> subdivision of any other state or with the United States , including, but not limited to , any bid <br /> or contract for goods or services to be provided to any public entity or an agency or political <br /> subdivision of any state or of the United States and involving antitrust, fraud, theft, bribery, <br /> collusion, racketeering, conspiracy or material misrepresentations . <br /> 5 . I understand that "convicted" or "conviction" as defined in Paragraph 287 .I33 ( 1 ) (b) , Florida <br /> Statutes , 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 by <br /> indictment or information after July 1 , 1989 , as a result of a jury verdict, non jury trail, or <br /> 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, means : <br /> a. A predecessor or successor of a person convicted of a public entity crime ; or <br /> b . An entity under control of any natural person who is active in the management of the <br /> entity and who has been convicted of a public entity crime . The term "affiliate" <br /> includes those officers , directors , executives, partners, shareholders , and employees, <br /> members , and agents who are active in the management of an affiliate . The Ownership <br /> by one person of shares constituting a controlling interest in another person, or a <br /> pooling of equipment or income among persons when not for fair market value under <br /> an arm ' s length agreement, shall be a prima facie case that one person controls another <br /> person. A person who knowingly enters into a joint venture with a person who has <br /> been convicted of a public entity crime in Florida during the preceding 36 months <br /> shall be considered an affiliate . <br /> F:\Purchasing\Bids\2003 -2004 FY (6000)\6080 Resurfacing on CR512 from SR 60 to Fellsmerc Fauns\6080 Bid Document. doc <br /> Page 40 of 61 <br />