Form_3_-_Public_Entity_Crimes_Certification.pdf
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- Solicitation number
- 26-0082MC
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is a Public Entity Crimes Certification form for RFP 26-0082MC submitted to the Lee County Port Authority in Florida for an Aircraft Rescue and Fire Fighting (ARFF) F3 Foam Transition project. The certification form serves as a sworn statement pursuant to Florida Statutes Section 287.133(3)(a), requiring proposers to confirm their eligibility to contract with the public entity. The form mandates that proposers certify that neither they nor their principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any state or federal entity. The certification must be notarized and is valid through December 31 of the calendar year in which it is filed.
The underlying project requires contractors to transition ARFF vehicles and equipment at Lee County Port Authority's two stations—Station 91 at Page Field (FMY) and Station 92 at Southwest Florida International Airport (RSW)—from aqueous film-forming foam (AFFF) to synthetic fluorine-free foam (SFFF). Work includes removal of AFFF storage tanks and associated piping, draining and removal of AFFF from seven ARFF vehicles, cleaning and rinsing of foam tanks and appurtenances, FAA-required testing of ARFF vehicles with SFFF, and disposal of waste materials including AFFF concentrate, rinsate, and bulk items from tanks and piping. Proposers must acknowledge that they are required to inform the public entity prior to contract execution of any changes to information contained in the certification form, and understand that convictions for public entity crimes result in a 36-month debarment period during which firms cannot transact business with public entities.
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Text version
RFP 26-0082MC: Aircraft Rescue and Fire Fighting (ARFF) F3 Foam Transition
FORM 3: PUBLIC ENTITY CRIMES CERTIFICATION
SWORN STATEMENT
PURSUANT TO SECTION 287.133(3) (a), FLORIDA STATUTES
A person, affiliate, or corporation who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal on a contract to provide any goods or services to a public entity, may not submit a proposal on a contract with a public entity for the construction or repair of a public building or public work, may not submit proposals on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, Florida Statutes, for Category Two for a period of thirty-six (36) months from the date of being placed on the convicted vendor list.
The Proposer certifies by submission of this form that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from participation in this transaction by any state or federal entity, department or agency.
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE PROCUREMENT AGENT FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS
FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO
ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION
287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION
CONTAINED IN THIS FORM.
[Signature] Notary Public
STATE OF ______________
COUNTY OF ____________
The foregoing instrument was signed and acknowledged before me this _______ day of _____________________, 20_____, by ____________________________________________ by means of physical presence or online notarization who produced the following as identification _________________________________ (type of identification) or is personally known to me.
My Commission Expires ________________ [stamp or seal]
[Signature of Notary Public]
[Typed or printed name]
Rev: 7.10.2026 Page 45 of 51
| COUNTY OF: |
| foregoing: |
| day of: |
| undefined: |
| 20: |
| online notarization who produced the following as identification: |
| type of identification or is personally known to me: |
| My Commission Expires: |
| Typed or printed name: |
| Check Box41: Off |
| Check Box42: Off |
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