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Exhibit " D "
<br /> SWORN STATEMENT PURSUANT TO SECTION 287 .133(3) (a)
<br /> FLORMA STATUTES, ON PUBLIC ENTITY CRIMES
<br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER
<br /> AUTHORIZED TO ADMINISTER OATHS.
<br /> F
<br /> 1 . This sworn statement is submitted to ,_ �_ ;� ,'• . „ n , f ! rte• � , „ f �, i ..�.1-• , F 5
<br /> (print name of public entVy)
<br /> by L - '.'v� . - 4 ; r c' n
<br /> (print individualls name and title) J
<br /> for �i,-� y r � ci4 ; AAAC } GC4�ri . njr:__
<br /> (print name ofen ry bmitting sworn statement)
<br /> whose business address is * A& _ o Vul /r
<br /> ll i
<br /> J /
<br /> and (if applicable) its Federal Employer Identification Number (FEIN) is (If the entity
<br /> has no FEIN, including the Social Security Number of the individual signing this sworn statement
<br /> L47- 0 :7 ;� 26E l.)
<br /> 2. I understand that- a "public entity crime" as defined in Faragraph 287•. 133(1 )(g), Florida Statutes, means . a
<br /> violation of any state or federal law by. a person with respect to and directly related to the transaction of buin
<br /> us
<br /> with any public entity or with an agency or political subdivision of any other staie or of the United States, including,
<br /> but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or
<br /> political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion,
<br /> racketeering, conspiracy, or material misrepresentation.
<br /> 3 . I understand that " cauvieted" or "conviction" as defined in Paragraph 287. 133 ( 1)(b), Florida Statutes, means a
<br /> finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or
<br /> state trial court of record relating to charges brought by indictment or information after July 1 , 1989, as a result of a
<br /> jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
<br /> 4. 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 the control of any natural person who is convicted.. of a .public entity crime. The term
<br /> "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents
<br /> who are active in the management of an affiliate. The ownership by oneperson of shares constituting a
<br /> controlling interest in another person, or a pooling of equipment or 'income amAng persons when not for fair
<br /> market value under 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 been convicted of a public
<br /> entity crime in Florida during the preceding 36 months shall be considered an affiliate.
<br /> 5 . I understand that a person as defined in Paragraph 287. 133 ( 1 )(e), F1a. Statutes means any natural person or entity
<br /> organized under the laws of any state or of the United States with the - legal power to enter into a binding contract
<br /> and whish bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which
<br /> other- wise transacts or applies to transact business with a public entity. The term "person" includes those officers,
<br /> direotors, executives, partners, shareholders, employees, members, and agents who are active in management of an
<br /> entity.
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