FORM_6_PUBLIC_ENTITY_CRIMES_CERTIFICATION.pdf
PDF 113 KB Posted
- Solicitation number
- 26-0068BW
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
This is a Public Entity Crimes Certification form for RFQ 26-0068BW submitted to the Lee County Port Authority in Florida. The form serves as a sworn statement certifying that the respondent and its principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in public entity contracts at the state or federal level. The certification must be notarized and is valid through December 31 of the calendar year in which it is filed. Respondents are required to inform the Lee County Port Authority of any changes to the information contained in the certification prior to entering into a contract exceeding the threshold amount specified in Section 287.017, Florida Statutes for Category Two.
The form implements Florida Statutes Section 287.133(3)(a), which prohibits individuals, affiliates, or corporations convicted of public entity crimes from submitting responses on contracts with public entities for a period of thirty-six months from the date of placement on the convicted vendor list. Respondents meeting these eligibility requirements must provide signatures witnessed by a notary public, including the notary's commission expiration date and identifying information.
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Text version
RFQ 26-0068BW: GENERAL PLANNING AND ENVIRONMENTAL SERVICES FOR THE LEE COUNTY PORT AUTHORITY
FORM 6: 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: 3.4.2026 Page 45 of 48
| COUNTY OF: |
| online notarization who produced the following as identification: |
| type of identification or is personally known to me: |
| Typed or printed name: |
| County of: |
| this day: |
| of: |
| year: |
| My Commission Expires: |
File details come from the government source that posted it. Updated .