HomeMy WebLinkAboutSworn StatementMiami -Dade County Public Schools
SWORN STATEMENT - NEW CONTRACTS
ATTACHMENT E
SWORN STATEMENT PURSUANT TO SECTION 1012.465,
FLORIDA STATUTES AS AMENDED BY
HB 1877, THE JESSICA LUNSFORD ACT
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY
PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to The School Board of Miami -Dade County, Fl
(Hereinafter "Board" or "School Board") by
for
(Print individual's name and title)
(Print Name of entity submitting sworn statement)
whose business address is
and its Federal Employer Identification Number (FEIN) is
. If the entity has no FEIN, include the Social Security
Number (SSN) of the individual signing this sworn statement and so indicate.
2. I, , am duly authorized to make this
(Print individual's name and title)
sworn statement on behalf of
(Print Name of entity submitting sworn statement)
3. I understand that during the 2005 Legislative Session, House Bill 1877, The Jessica Lunsford
Act (hereinafter "The Act" or "Act") was passed and approved by Governor Bush on May
2, 2005, with an effective date of September 1, 2005.
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4. I understand that the Act amends the background screening requirements of section
1012.465, Florida Statutes (2004) for all non -instructional school district employees or
"contractual personnel" by requiring all non -instructional school district employees or
contractual personnel who are permitted access on school grounds when students are present
to undergo and pass "level 2 background screening," and further I understand the Act defines
"contractual personnel" to include any vendor, individual, or entity under contract with the
Board.
5. I understand that pursuant to section 1012.465, Florida Statutes as amended by the Act, non -
instructional school district employees or contractual personnel who are permitted access on
school grounds when students are present, who have direct contact with students or who
have access to or control of school funds must meet level 2 screening requirements as
described in sections 1012.32 and 435.04, Florida Statutes.
6. I understand that as a (eg. a private bus
Type of entity
service contractor) all contractual personnel, as defined in section 1012.465, Florida
Statutes, must meet level 2 screening requirements as outlined in sections 1012.32
and 435.04, Florida Statutes in order to do business with The School Board of
Miami -Dade County, Florida.
7. I understand that "level 2 screening requirements," as defined in sections 1012.32 and
435.04, Florida Statutes means that fingerprints of all contractual personnel must be obtained
and submitted to the Florida Department of Law Enforcement for state processing and to the
Federal Bureau of Investigation for federal processing.
8. I understand that the School Board will implement local procedures to comply with level 2
screening requirements, as defined in sections 1012.32 and 435.04. I understand that my
company must comply with these local procedures as they are developed.
9. I understand that any costs and fees associated with the required background screening will
be borne by my company.
10. I understand that any personnel of the contractor found through fingerprint processing and
subsequent level 2 background screening to have been found guilty of, regardless of
adjudication, or entered a plea of nolo contendere or guilty to any offense outlined in Section
435.04, Florida Statutes (or any similar statute of another jurisdiction), shall not be permitted
to come onto school grounds or any leased premises where school -sponsored activities are
taking place when students are present, shall not be permitted direct contact with students,
and shall not be permitted to have access to school district funds.
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11. I understand that the failure of any of the company's or my affected personnel to meet level
2 screening standards as required by section 1012.465, Florida Statutes, may disqualify my
company from doing business with The School Board of Miami -Dade County, Florida.
12. I hereby certify that the foregoing statement is true and correct in relation to the company
for which I am submitting this sworn statement. I further certify that this statement is being
given knowingly and voluntarily by me on behalf of my company.
The company submitting this sworn statement agrees to be bound by the provisions of SECTIONS
1012.32, 1012.465, AND 435.04 OF THE FLORIDA STATUTES AS AMENDED BY HB 1877,
THE JESSICA LUNSFORD ACT 2005.
I CERTIFY THAT THE SUBMISSION OF THIS FORM TO THE SCHOOL BOARD OF MIAMI-
DADE COUNTY, FLORIDA ON BEHALF OF THE COMPANY IDENTIFIED IN PARAGRAPH
ONE (1) ABOVE BINDS THE COMPANY TO FULLY COMPLY WITH THE BACKGROUND
SCREENING REQUIREMENTS OF SECTIONS 1012.32, 1012.465, AND 435.04, FLORIDA
STATUTES.
(Signature)
Sworn to and subscribed before me this day or , 20 .
Personally known
OR Produced Identification
Notary Public -State of
My commission expires
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(Type of Identification)
(Printed typed or stamped commissioned
name of notary public)
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