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I
<br /> IAppendix Ill — Proposal Forms (continued)
<br /> Imarket value under an arm's length agreement, shall be a prime fade 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 /> Iconsidered 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 finding 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 /> I 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 /> X 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 /> I 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 /> I affiliate of the entity has teen 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 /> I 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 /> I 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 /> t UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br /> I 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 W1-IICH 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 THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br /> STATUTES,FOR CATEGORY TWO OF ANY.CHANGE IN THEQINFORMATION CONTAINED IN THIS FORM.
<br /> I By:
<br /> gt 1CiVJ*A-0-'
<br /> (Signature)
<br /> Pablo Llerena
<br /> I (Printed Name)
<br /> Partner
<br /> (Title)
<br /> I
<br /> cr /
<br /> --2Sworn to and subscribed before me this a/ day of / 4 20/ r,by
<br /> 4-4/0 .-'<GEQ.7CL
<br /> (AFFIX%. • r FF
<br /> .
<br /> EXPM&Notts 16,2019 2019 SignatuJg Notary Public—State of Floridaq�nd 1We0 RJv Bidpe1fk275eria J24 Jew... C-41-.474
<br /> Print or Type Commissioned Name
<br /> I Personally Known ✓ OR Produced Identification
<br /> Type of Identification Produced
<br /> ty;c,e 3 G 7
<br /> I
<br /> PROPOSAL
<br /> GL$C&COMPANY, PLLC RFP # 15-12-01
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