2004-188 - Laserfiche WebLink

Home Browse Search

SWORN STATEMENT UNDER SECTION 287 .I33 (3) (N) , FLORIDA STATUTES ON PUBLIC ENTITY CRIMES THIS FORM 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, Proposal or Contract No . I QL° #tk665Z for F& Sm 2E� ¢ RoSEtA,100 Rezmavwv L A V544P4E Pian Tt2T 2 . This sworn statement is submitted by 1A/L40 whose business address is 5l9! SS"U' ST W VERO Bfbtl,N 0 AFL 0 327467 and ( if applicable) its Federal Identification No . (FEIN) is 6S' 09A 06440 . If entity has no FEIN, include the Social Security Number of the individual signing this sworn statement : 3 . My name is 45PPA94 L . DEPU and my relationship to the entity named above is PRS I QeV7 4 . I understand that a "public entity crime" as defined in Paragraph 287 . I33 ( 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 an 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 state or of the United States and involving antitrust, fraud , theft, bribery, collusion, racketeering, conspiracy or material misrepresentations . 4 5 . I understand that "convicted" or "conviction" as defined in Paragraph 287 . I33 ( 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, non jury trail , or entry of a plea of guilty or nolo contendere . 6 I understand that an "affiliate" as defined in Paragraph 287 . I33 ( 1 ) (a) , Florida Statutes, means : a . A predecessor or successor of a person convicted of a public entity crime ; or b . An entity under control of any 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 , and employees , members , and agents who are active in the management of an affiliate . The Ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm ' s length agreement, shall be a prima facie case that one person controls another person . A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate . 6706 -3866612/5 /04 Page 41 of 59 VRB