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market value under an arm's length agreement,shall be a prime facie case that one person
<br />controls another person.A person who knowingly enters into a joint venture with a person who
<br />has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br />considered an affiliate.
<br />11.5.I understand that a "person"as defined in Para.287.133(1 )(e),Florida Statutes,means any natural
<br />person or entity organized under the laws of any state or of the United States with the legal power to
<br />enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or
<br />services let by a public entity,or which otherwise transacts or applies to transact business with a public
<br />entity.The term "persons"includes those officers,directors,executives,partners,shareholders,
<br />employees,members,and agents who are active in management of any entity.
<br />11.6.1 Based on information and belief, the statement which I have marked below is true in relation to the entity
<br />submitting this sworn statement.(Indicate which statement applies.)
<br />Neither the entity submitting this sworn statement,nor any of it's officers,directors,executives,partners,
<br />shareholders,employees,members,or agents who are active in the management of the entity, nor any
<br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br />1989.
<br />The entity submitting this sworn statement,or one or more of its officers,directors,executives,partners,
<br />shareholders,employees,members,or agents who are active in the management of the entity, or an
<br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br />1989.
<br />The entity submitting this sworn statement,or one or more of its officers,directors,executives,partners,
<br />shareholders,employees,members,or agents who are active in the management of the entity, or an
<br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br />1989.However,there has been a subsequent proceeding before a Hearing Officer of the State of
<br />Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the
<br />State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
<br />determined that it was not in the public interest to place the entity submitting this sworn statement on the
<br />convicted vendor list. (Attach a copy of the final order.)
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br />THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED.I
<br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017,FLORIDA
<br />STATUTES,FOR CATEGORY TWO OF ANY,CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br />By:ktJi A•i/PJ)^
<br />(Signature)(Signature)
<br />(Printed Name)
<br />(Title)
<br />Sworn to and subscribed before me this c*W day of rXJp'fiiCi.TU ,20 [jj ,by
<br />(AFFIX NOTARY ST/
<br />Personally Known /
<br />i milt
<br />.^'"kv.DEB8IE WALSH#2PSE)MY COMMISSION *FF 93533*
<br />faJBLS EXPIRES:November 11,2019v^3W Bended Thru Notary Pubfc Undcnuntsra Signature:/^
<br />OR Produced Identification
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