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11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to .. enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, �k ; employees, members, and agents who are active in management of any entity. ' R 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity ISA submitting this sworn statement. (indicate which statement applies.) 5� X Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners, { shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. t The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, ` 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an i, affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989, However, there has been a subsequent proceeding before a Hearing Officer of the State of Ia: •� Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) r, •: N I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE 1S FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO s A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM, i+1r By. \� !! ; (Signature) TArckcAo A9k.Ocm (Printed Name) PtCS��c1� ;l (Title) Sworn to and subscribed before me this Z& day of No Vt,&16e,1- 20 23 , by fer Yia.ctQ MtAtIGrc (AFFIX NOTARY STAMP HERE) ��qv pOH JOSE JAIMES Si nature: z° Notary Public, Stale of Florida g Commission# HH 323046 My comm. expires Oct, 17, 2026 Personally Known OR Produced Identification FL l YtrJ f CB A J -e, 297 Is market value under an arm's length agreement, shall be a prime facie case that one person ' controls another person. A person who knowingly enters into a joint venture with a person who s'''• has been convicted of a public entity crime in Florida during the preceding 36 months shall be ;► ,;.. considered an affiliate. 11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to .. enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, �k ; employees, members, and agents who are active in management of any entity. ' R 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity ISA submitting this sworn statement. (indicate which statement applies.) 5� X Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners, { shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. t The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, ` 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an i, affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989, However, there has been a subsequent proceeding before a Hearing Officer of the State of Ia: •� Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) r, •: N I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE 1S FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO s A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM, i+1r By. \� !! ; (Signature) TArckcAo A9k.Ocm (Printed Name) PtCS��c1� ;l (Title) Sworn to and subscribed before me this Z& day of No Vt,&16e,1- 20 23 , by fer Yia.ctQ MtAtIGrc (AFFIX NOTARY STAMP HERE) ��qv pOH JOSE JAIMES Si nature: z° Notary Public, Stale of Florida g Commission# HH 323046 My comm. expires Oct, 17, 2026 Personally Known OR Produced Identification FL l YtrJ f CB A J -e, 297