The document is a sworn statement form that is submitted to a public entity by an individual on behalf of an entity. The form includes information about the entity, such as its business address and Federal Employer Identification Number (FEIN). It also provides definitions of terms related to public entity crimes, such as "public entity crime," "convicted," "affiliate," and "person." The individual signing the sworn statement confirms whether the entity or any of its officers, directors, executives, partners, shareholders, employees, members, or agents have been charged with and convicted of a public entity crime. The form also mentions the possibility of a subsequent proceeding before a Hearing Officer, which may result in the entity not being placed on the convicted vendor list. The individual signing the form acknowledges that it is valid only for the specified public entity and must be updated if there are any changes in the information provided. The document also includes a section for notarization. The context information mentions that this sworn statement form is related to a bid specification for electrical work at various Santa Rosa County School Board sites, including softball stadiums and parking lot lighting, which may require working out of a bucket truck or basket and crane.