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<br />market value under an ,arm's length agreement, shall be a prime facle 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 />5. 1 understand that a "person" as defined in .Para. 157.133(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 Corrtraet and which Bids or applies to Bid an Contracts for the provision of goods or
<br />services tet 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 />6. Based on information and belief, the statement which I have marked below is true in ralation to the entity
<br />submitting this sworn statement, (indicate which statement applies.)
<br />x Nelther 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 was are active in the management of the entity, or an
<br />affiliate of the eritity 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 />a ifiste of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br />1988. However,. there has been a subsequent proceeding before a Nearing 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 BUBM18510N OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 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.
<br />ALSO UNDERSTAND THAT t AM REQUIRED TV INFORM T E PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE THRESF At
<br />T PROVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF A, Y, CHANGE I H MATION CONTAINED IN THIS FORM.
<br />By. . 1
<br />KrWy Fupra. Y.. ,..-
<br />(Printed Name)
<br />Vim PrrsidnrrJSsrataryirrrssarw
<br />(Title) —
<br />Sworn to a subscribed b fore me this day of L2D fb by
<br />��
<br />(AFFIX NOTARY STAMP HERE)
<br />Signature; Noiary'Publid: Stat�.v#-Fforid±
<br />Print or Type Commis.—stoned Name. s_
<br />Personally Known OH Produced Identification = -
<br />-_ GARY A'DELA=HE
<br />Type of Identification Prociured NOTARY PUBLIC
<br />3 of 10 State of Louisiana, Bar No. 19550
<br />MCommission is for life
<br />117
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