|
m.Arke-4. value under anj amil"s. length, agreement, ahaA tm a poinum fa dese than: ane pemn.
<br />rmntro-L5 mnothm person, A person who knowingly on IeTS I FYI .0 -a joint Venture'With a perrion! Who.
<br />hep been convIated of Bpublic arjlAy Orme in FlorkIa &U.Mg thl's premdIng 30. mcm ft. ahWI be,
<br />considerell an affiliate,
<br />S.: Ii undarstand that as "Parsort- as, deilnedi to Pam, Flb.rida Statwtm% emany naft"I
<br />peft-an of afift,organiZed under the tows of ,any stale or; of,Whs- United States w0i Mal Fog -al Wirer' to,
<br />anlag into a bind ing Q?--ntrect aid which Bids or appWa to, Bid on Coniracts 'for thaprovmoon of - goods or
<br />mvIces lat by of public anifty, or whloh, othm
<br />wise, ltramsWs stir appliasto transactibusliness lArith a pubilici
<br />andly. The Iorrm mpersone imidudes three offi'cers, 4f ,M!executives. partnerssh- OP6 dr's,
<br />amptoyeas, members, and ageaft who me. active, In management, of any entity,
<br />8ased Oni IM-lom elfan end tkeffef, thastaterment which I have marked WOW Ess 1ruain falafion to Iha entity.
<br />tubmiktingThis mmmatement.,
<br />RharehoWers., employees. me im ber% & agon,is, who are achve in them.na-gement of- IM, entity, nor any
<br />affiliate of the en* has been &aftjodl with and convit-Led of a publin aiaty cAme subs
<br />1989, waqvenj. tg. July t.,
<br />The entliTy s-ubimjdfN rn 9,191umnlv, or o"! ar rem are of its -aff'Wa timert1wes, partnems,
<br />- Ihis swor I- - - - - - - T%
<br />shareholders, Q.'MqIoyW5, IMWMbe..M, Or agafN L %
<br />Im 010 are arthm In Ww managernem, of -the enftj, or an
<br />afflli4ia of !hB imilsy h#11L b#jft,nj ChaMind imilh mW immicted of a ptabIla enillty e0m, e mjjbwqV nt 1n juty
<br />The ant4submWIN !his Bwom. sialemem, or ons or, m of its ofiff-cafti d1redlom execmWes, P, artmers,
<br />shareholdera, empiwees, mem1mrs, or agents who afar ftdVa [a ffia Mahogornerqtof UM, 6.mfity, or an
<br />arlMili CM a au j8q
<br />f thine e0
<br />e ft bas been charpedl with and, cofivic-I&A of a pukWic eWAm y - ba ' usni. to, July, 1,
<br />119M. ' HokWmr, there; has began a subfi"Lfenk procaddino before a flea fog Ofter of- the, Maio of-
<br />RON"Pr Division of Adm kn, istmativo Hewing& and the Fimal Ordst enter -ad by the: Hearfing Off cee -of the
<br />Stafte of Flmlda, Division of Adm loistmikoa Rearings, and We iRnali Otder enteirdd 00ha Heasing, Offinar
<br />determined ftl 11 was ml in, (he public irl-Wast to pfaafa� the enfity gubmitIMg.
<br />thia smewn statement on One
<br />convIded Vandur 06L (Altacha copy of the feel! order.1
<br />t UNDERSTAND THAT, TINIPSUGMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIF1150, IN PARAGRAPH 1 (ONE) ABOVE IJS FOR THAT PUBLIC ENTITY ONLY RNID,
<br />THAT TKIS FORM 19 VAUD THROUGH DECEMBER. 31 OF THE. CALENDAR: YEAR IN WHIICH 17 IS FILED, I
<br />ALSO, UNDERSTANO T14AT I AMREQUIRED TO INFORM THE PUBLIC EWWITY PFVOR TO IENTERING IWO
<br />A CONTRACT IN ZEXCESS OF THE THRESHOLD AMOtJNT PROVIDED IN SECTION 287.07, FLORIDA
<br />STATUTM FOR CATEGMY TWO DQE ANY, CHANGE IN THE INFORMATION CONTAINED KFOR THIS
<br />I .
<br />A
<br />Sworn to, and gubscribad: bef;ore me Il is d4yn V--kh-1%y 20 --
<br />SI nage; Notary !PLV lie: ® State of Morlida
<br />"' oma s
<br />Tyra v -i Comrrh ongid Namet
<br />Persvorkityi wwwn OR Produced Identi.M.ea.4ion.
<br />Tm.., of ldrialift-WIon Produced QJJ,Qe�,,�(f' Jj,:r:�2p-,t0",e q 1�11:6; 01 161 W-3 I>
<br />off
<br />rfA- IGa Att IratG+t-V4 -4d Wlow4 reltover,
<br />A
<br />R"FIR A- 25 - 0,65
<br />
|