FORM_6_PUBLIC_ENTITY_CRIMES_CERTIFICATION.pdf
PDF 114 KB Posted
- Solicitation number
- 26-0078BW
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is a Public Entity Crimes Certification form for RFQ 26-0078BW, issued by the Lee County Port Authority in Florida for Architectural and Engineering Services related to the Southwest Florida International Airport (RSW) New Long Term Parking Lot project. The certification form is a sworn statement required by Section 287.133(3)(a) of Florida Statutes, confirming that respondents and their principals are not on the convicted vendor list and have not been debarred, suspended, or declared ineligible by any state or federal entity. The form must be notarized and submitted to the procurement agent for the Lee County Port Authority. Respondents are required to acknowledge that the form is valid only through December 31 of the calendar year in which it is filed and that they must notify the public entity of any changes to the information provided prior to entering into a contract exceeding the Category Two threshold amount specified in Section 287.017 of Florida Statutes.
Vendors convicted of public entity crimes are prohibited from submitting responses, performing work as contractors or consultants, or transacting business with the public entity for a period of thirty-six months from the date of placement on the convicted vendor list. This certification requirement applies to all responses submitted in connection with RFQ 26-0078BW and serves as a prerequisite condition for participation in the procurement process. The form is available through the Lee County Port Authority's procurement portal at https://procurement.opengov.com/portal/flylcpa.
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Text version
RFQ 26-0078BW: ARCHITECTURAL AND ENGINEERING SERVICES FOR SOUTHWEST FLORIDA INTERNATIONAL AIRPORT (RSW) NEW
LONG TERM PARKING LOT
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: 5.28.2026 Page 49 of 52
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