FORM_4_-_PUBLIC_ENTITY_CRIMES_CERTIFICATION.pdf
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- Solicitation number
- 2026-072-MC
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
This is a Public Entity Crimes Certification form (Form 4) required for RFQ 2026-072-MC, issued by the Lee County Port Authority in Florida for a Progressive Design-Build project involving a parking garage, Quick Turnaround Area (QTA), and demolition/remediation of existing facilities at Southwest Florida International Airport. By submitting this sworn statement, respondents certify that neither they nor their principals are currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any state or federal entity. The certification applies only to the specific public entity receiving it and remains valid through December 31 of the calendar year in which it is filed.
Respondents are required to comply with Florida Statute Section 287.133(3)(a), which prohibits individuals, affiliates, or corporations on the convicted vendor list from submitting responses, performing work as contractors or subcontractors, or transacting business with any public entity for a thirty-six-month period following placement on the list. Respondents must notify the public entity of any changes to the information contained in this certification prior to entering into any contract exceeding the Category Two threshold amount established under Florida Statute Section 287.017. The form must be notarized and signed by an authorized representative before submission to the procurement agent.
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Text version
RFQ 2026-072-MC: PROGRESSIVE DESIGN-BUILD FOR PARKING GARAGE, QUICK TURNAROUND AREA (QTA), AND DEMOLITION/REMEDIATION OF EXISTING FACILITIES
FORM 4: 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 response on a contract to provide any goods or services to a public entity, may not submit a response on a contract with a public entity for the construction or repair of a public building or public work, may not submit to acquire 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 Respondent 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: 6.29.2026 Page 44 of 58
| COUNTY OF: |
| foregoing: |
| this: |
| 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: |
| Typed or printed name: |
| Check Box5: Off |
| Check Box6: Off |
File details come from the government source that posted it. Updated .