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5.
<br />6.
<br />X
<br />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 affil iate.
<br />understand that a "person" as defined in Para. 287 .133(1 )(e), Florid a Statutes , me ans 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 Jet 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 age nts who are active in management of any entity.
<br />Based on information and belief, the statement which I have marked below is true in relation to the entity
<br />submitting th is sworn statement. (Indicate 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 />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 th is 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 , o r an
<br />affiliate of the entity has been charged wi th and convicted of a public entity crime subsequent to July 1,
<br />1989 .
<br />The entity submitting th is 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 Admin istrative 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 IDENTIFI ED 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 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 THRES OLD MOUNT PROVIDED IN SECTION 287 .017 , FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF A , C A IN E INFORMATION CONTAINED IN THIS FORM .
<br />By :
<br />(Title)
<br />Sworn to and subscribed before me this 14th day of __ J_u_IY _______ , 20~, by
<br />Luis A Betalleluz
<br />(AFFIX NOTARY S~J:Jf~
<br />S Notary Public
<br />· State of Florida
<br />Comm• HH334347 ~'-tee 'i'' Expires 1/15/2027
<br />Notary: Michelle C. Lopez
<br />Signature : w o.a ~
<br />Personally Known __ X ___ OR Produced Identification-----------------
<br />80 The BetaJones Group/RFQ#26-07-01
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