ITB202608_CDBG_Infrastructure_Improvement_Project__Exhibit_G.pdf
PDF 163 KB Posted
- Attached to
- Infrastructure Improvement Project
- Solicitation number
- ITB-2026-08 CDBG
- Issued by
- Santa Rosa County, Florida
About this file
This is a Public Entity Crimes Affidavit for ITB-2026-08, a Community Development Block Grant (CDBG) Infrastructure Improvement Project issued by the City of Milton, Florida. The affidavit represents a mandatory compliance document that all bidders must execute and submit as part of their bid package. A mandatory pre-bid conference and site visit will be held on Tuesday, July 21, 2026, at 11:00 A.M. at the City of Milton Council Chambers, located at 6738 Dixon Street, Milton, FL 32570, with the site visit following the pre-bid meeting. The sealed bid submission process is governed under Florida Statutes authority 287.133.
The affidavit requires the authorized bidder representative to swear under penalty of perjury that neither the bidder nor any of its affiliates are currently listed on the State of Florida's Convicted Vendor List following a conviction for a public entity crime as defined in Florida Statutes 287.133. The sworn statement must be notarized and constitutes a material representation of fact upon which the City will rely during bid evaluation. Submission of a false affidavit may result in bid rejection, contract termination, and other remedies available under applicable law. The document includes signature blocks for the bidder's authorized representative, a notary public, and required fields for commission information and expiration dates.
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Text version
EXHIBIT G – PUBLIC ENTITY CRIMES AFFIDAVIT
CDGB Infrastructure Improvement Project
Authority: § 287.133, F.S.
Contract No. CDBG-CON-01
Before me, the undersigned authority, personally appeared ___________________, who, being duly sworn, states that:
1. The undersigned is authorized to execute this sworn statement on behalf of
__________________________ (“Bidder”).
2. The Bidder is not currently on the State of Florida’s Convicted Vendor List following a conviction for a public entity crime, as defined in §287.133, Florida Statutes.
3. No affiliate of the Bidder is currently on the Convicted Vendor List following a conviction for a public entity crime.
4. This affidavit is a material representation of fact upon which the City will rely in evaluating the Bid.
The Bidder understands that submission of a false sworn statement may result in rejection of the
Bid, termination of any resulting contract, and any other remedies available under applicable law.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated herein are true.
Bidder/Contractor: ___________________________________________
Authorized Signature: ______________________________________________
Printed Name: _____________________________________________________
Title: _____________________________________________
Date: ____________________________________________
STATE OF FLORIDA | COUNTY OF __________________
Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online notarization this ____ day of ________________, 20, by
_______________________________________, who is ☐ personally known to me OR ☐ produced _______________________________ as identification.
Signature of Notary: ___________________________
Print Name: __________________________________
Commission No.: _______________________________
My Commission Expires: ________________________
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