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market value under an amts 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 arty state or of the United States with the legal power to
<br />enter into a birding 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 tens " persons" includes those officers, directors, executives, partners, shareholders,
<br />R employees, members, and agents who are active in management of any entity.
<br />11.E Based on information and belief, the statement which I have marked below is true in relation to the artily
<br />subntthrig this swom statement (Indicate which statement applies.)
<br />X Neither the entity submitting this swom statement, nor any of its 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 />1969.
<br />The entity submitting this swum 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 swom 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 swom 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 R 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 E INFORMATION CONTAINED IN THIS FORM.
<br />B':
<br />(Signature)
<br />Michae hgueredo
<br />(Printed Name)
<br />Principal
<br />(Title)
<br />Sworn to and subscribed before me this 17' day of AV( I'S % , 20LJ_ by
<br />MICHAEL PILU6,2EDO
<br />(AFFIX NOTARY STAMP HERE) 7 Y I
<br />�,W 0%, Notary Pudic Sate of Florida Signature: Notary Public — State of Florida
<br />Y. Marisela Conde i1AR/S'G COA/019
<br />e My co iasiom EE 219113 Print or Type Commissioned Name
<br />p�T Expim607/24/2076
<br />Pe �I fication
<br />Type of Identification
<br />,p.m 3tar7
<br />
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