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<br /> ® market value under an arm's length agreement, shall be a prime facie case that one person
<br /> e controls another person. A person who knowingly enters into a joint venture with a person who
<br /> O has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br /> • considered 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 any state or of the United States with the legal power to
<br /> o 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 /> o 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 /> OX 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 /> O 1989.
<br /> O _ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> O 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 /> OThe entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> O 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 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 THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br /> • STATUTES, FOR CATEGORY TWO OF ANY, CH IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> •
<br /> • By:
<br /> (Sig :tu
<br /> • Jorge Ferrer
<br /> • (Printed Name)
<br /> • Vice President
<br /> (Title)
<br /> • Sworn to and subscribed before me this 30 day of Arc) , 20 12— , by
<br /> \• ,
<br /> (AFFIX NOTAPv STAr I iciL) 'tsar
<br /> Arcata CAMACHO (7 V
<br /> • MYCoMMISS1ON#EE1145E0 Signature: Notary Public—.Statenf Florida
<br /> EXPIRES:July 21,2015
<br /> • Bonded'Mu Way Raeourdn.een Arciell(ci Lc�
<br /> ncnc.kko
<br /> • Print or Type Gommissioned Name
<br /> • Personally Known OR Produced Identification
<br /> •
<br /> • Type of Identification Produced
<br /> • lame of 7 65
<br /> •
<br /> •
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