Form_5_Public_Entity_Crimes_Certification.pdf
PDF 103 KB Posted
- Attached to
- Landscaping Services at Page Field
- Solicitation number
- 26-0080LB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is a Public Entity Crimes Certification form for RFB 26-0080LB, a landscaping services solicitation for Page Field Airport in Florida. The form serves as a sworn statement certifying that bidders and their principals are not on the convicted vendor list and have not been debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in public entity contracts by any state or federal agency. The certification is valid through December 31 of the calendar year in which it is filed and applies specifically to the public entity identified in the procurement process. Bidders are required to inform the public entity of any changes to the information contained in the form prior to entering into a contract exceeding the threshold amount specified in Florida Statutes Section 287.017 for Category Two.
The form requires notarization and includes signature blocks for both the bidder and a notary public, along with fields for the state and county where notarization occurs and the notary's commission expiration date. Submission of this certification is mandatory for participation in this procurement opportunity and constitutes acknowledgment of the bidder's understanding of the restrictions imposed on convicted vendors under Section 287.133(3)(a) of the Florida Statutes, which prohibit such entities from submitting bids, being awarded contracts, or conducting business with public entities for a period of thirty-six months from the date of placement on the convicted vendor list.
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Text version
RFB 26-0080LB: LANDSCAPING SERVICES AT PAGE FIELD
FORM 5: 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 bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids 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 Bidder 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: 3.24.2026 Page 53 of 61
| COUNTY OF: |
| undefined: |
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| 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: |
| Text10: |
| Check Box11: Off |
| Check Box12: Off |
File details come from the government source that posted it. Updated .