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5.
<br />6.
<br />,/
<br />market value under an arm's length agreement, shall be a prime facie case that one person
<br />conlrols 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 afliliate.
<br />I understand that a "person" as defined in Paru. 287.133(1Xe), Florida Statutes, means any natural
<br />person or entity organized under the laws of any state or ol 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 ol 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 />Based on intormation and belief, the statement which I have marked below is true in relation to the entity
<br />submitting this sworn statement. (lndicate 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 />afliliate ol the entity has been charged with and convicted ol a public entity crime subsequent to July 1,
<br />1989.
<br />The entity submitting this sworn statement, or one or more ol its officers, directors, executives, partners,
<br />shareholders, employees, members, or agents who are active in the management ol the entity, or an
<br />atfiliate ol the entity has been charged with and convicted of a public entity crime subsequent to ..tuty t,'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 entiiy, or an
<br />atliliate ol the entity has been charged with and convicted ol a public entity crime subsequent to ..tuty t,1989. However, there has been a subsequent proceeding before a Hearing Oflicer of the State of
<br />Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Oflicer of the
<br />State of Florida, Division of Administrative Hearings and the Final Order eniered 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 linal order.)
<br />IUNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICEB FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGBAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br />THAT THIS FORM IS VALID THBOUGH DECEMBEB 31 OF THE CALENDAFI YEAR IN WHICH IT IS FILED. I
<br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFOBM THE PUBLIC ENTITY PBIOR TO ENTERING INTOA CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES, FOB CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br />By Sld) !, V
<br />(Signature)'f tt.t +t \c- L Dtr
<br />(Printed Name)
<br />VP . { ga-\c..
<br />-TtsA
<br />(Title)
<br />Sworn to and subscribed before me this -+^-s day ol J4...,+r eo-)3, uy
<br />sis
<br />a;
<br />nature: N
<br />6l ublic - State of Floridack H.p,<L-
<br />Print or Type Commissioned Name
<br />Produced ldentification
<br />h L. D+Aiis
<br />(AFFIX NOTABY STAMP HERE)
<br />***q.
<br />r{(Sr.i.r..9! r!.:.
<br />BIiI U/TEELT HACX
<br />Not.ry Publi.-St.te of Flortd.
<br />Com,n ri ion t 208ftt 20 21
<br />Type ol ldentif ication Produced
<br />3ol 8
<br />Iy Comn.1,
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