|
market value under an arm's 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. l 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 any state or of 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 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 term "persons" includes those officers, directors, executives, partners, shareholders,
<br />employees; members, and agents who are active in management of any entity.
<br />11.6. Based on information and belief, the statement which .I have marked below is true in relation to the entity
<br />submitting this sworn statement. (Indicate which statement applies.)
<br />k Neither the entity submitting this swam 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 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 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 />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 sworn 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 1.1.1 (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, I
<br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE THRWO D AM UN1--y ROVIDED 1N SECTION 287.017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF , CHA G N THE I FORMATION CONTAINED IN THIS FORM.
<br />By.
<br />(Printed Name) r}}
<br />MttsSltpaUT'
<br />(Title)
<br />Sworn t and bscribedbefore me this ZG day of 3cafjG 24 ZS by
<br />41)CL t Ya
<br />{AFFIX NOT IA CHADFlorlds
<br />�` a ',Notary Public -State Commission # HHMy Commission April 18, 10
<br />Signature:
<br />�R
<br />Personally Known OR Produced ldentification
<br />
|