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<br />I <br />II <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />I <br /> <br />SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), <br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES <br /> <br /> <br />1. <br /> <br />~I,-L~ /~~ <br />ntity] <br /> <br />by <br /> <br />for <br /> <br />whose business address is <br />12054 N.W. 98th Avenue. Hialeah ~~~ <br /> <br />and (if applicable) its Federal Employer Identification Number (FEIN) is ~ ~Z.~~, <br /> <br />2. <br /> <br />(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn <br />statement: .) <br /> <br />I understand that a "public entity crime" as defined in Paragraph 287.133(1 )(g), Florida Stafutes, <br />means a violation of any state or federal law by a person with respect to and directly related to <br />the transaction of business with any public entity or with an agency or political subdivision of any <br />other state or of the United States, including, but not limited to, any bid or contract for goods or <br />services to be provided to any public entity or an agency or political subdivision of any other <br />state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, <br />conspiracy, or material misrepresentation. <br /> <br />3. <br /> <br />I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1 )(b), Florida <br />Statues, 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, nonjury trial, or entry of a <br />plea of guilty or nolo contendere. <br /> <br />I understand that an "affiliate" as defined in Paragraph 287.133(1 )(a), Florida Statutes, means: <br /> <br />4. <br /> <br />5. <br /> <br />1. A predecessor or successor of a person convicted of a public entity crime; or <br />2. An entity under the 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" includes those <br />officers, directors, executives, partners, shareholders, employees, members, and agents who <br />are active in the management of an affiliate. The ownership by one person of shares <br />constituting a controlling interest in another person, or a pooling of equipment or income among <br />persons when not for fair market value under an arm's length agreement, shall be a prima facie <br />case that one person controls another person. A person who knowingly enters into a joint <br />venture with a person who has been convicted of a public entity crime in Florida during the <br />preceding 36 months shall be considered an affiliate. <br /> <br />I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any <br />natural person or entity organized under the laws of any state or of the United States with the <br />legal power to enter into a binding contract and which bids or applies to bid on contracts for the <br />provision of goods or services let by a public entity, or which otherwise transacts or applies to <br />transact business with a public entity. The term "person" includes those officers, dir~ctor~, <br />executives, partners, shareholders, employees, members, and agents who are active In <br />management of an entity. <br /> <br />05/08 Final Version <br /> <br />00402-1 <br /> <br />05-4893 <br />