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STATEMENT OF PUBLIC ENTITY CRIMES This form is a sworn statement under Section 287. 133 (3 )(a), Florida Statutes, on public entity crimes and must be signed in the presence of a notary public or other officer authorized to administer oaths . 1 ) This sworn statement is submitted with Bid No . 6031 for MITIGATION REEF PROJECT - SHORELINE SECTORS 1 & 2 (AMBERSAND BEACH) 2) This sworn statement is submitted by (name of entity submitting sworn statement) whose business address is and (if applicable) its Federal Employer Identification Number (FEIN) is (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement : 3 ) My name is (please print name of individual signing) and my relationship to the entity named above is 4) I understand that a 'Public Entity Crime" as defined in Paragraph 287 . 133 ( 1 )(g), Florida Statutes, means : a violation of any State or Federal law by a person with respect to and directly related to the transaction of business with any public entity or with any agency or political subdivision of any other State or with the United States, including, but not limited to , any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 5) I understand that "convicted" or "conviction" as defined in Paragraph 286 . 133 ( 1 )(b) Florida Statutes , means : a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any Federal or State trial court of record relating to charges brought by indictment or information after July 1 , 1989 , as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 6) I understand that an " affiliate" as defined in Paragraph 287 . 133 ( 1 )(a) , Florida Statutes , means : a . A predecessor or successor of a person convicted of a public entity crime ; or b . An entity under the control of a natural person who is active in the management of the entity and who has been convicted of a public entity crime . The term " affiliate " includes those officers , directors , executives , partners , shareholders , employees , members , and agents who are active in the management of an affiliate . STATEMENT OF PUBLIC ENTITY CRIMES S- 1