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'`tlAtf17,, r_ Oi .SUNNY ISLES BEACtr H Nt' t2r„ w
<br /> USECATI®N'SI,X�AC®NTRACT, F® RMS`M `;' r :41.4 ``;.-4± f /,,.:" i " 4a`w fi try ®
<br /> market value under an arm's length agreement, shall be a prime facie case that one person QD
<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. 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 /> 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 publicfte
<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 40
<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, 1;T
<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, j,
<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 11.1 (ONE)ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, 0
<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, CHANGE IN THE
<br /> JINFORMATION CONTAINED IN THIS FORM.
<br /> 0
<br /> By: sielik
<br /> Z
<br /> 40
<br /> (Signature)
<br /> Michael L.Davis
<br /> (Printed Name)
<br /> Vice President
<br /> (Title) n I
<br /> •
<br /> Sworn to and subscribed before me this 30 day of Ai/t2.1 , 20)2. , by
<br /> a ass.
<br /> lir(AFFIX NOTAR cTAMP HERE) /�!._�i'��!� /'!-
<br /> „t MARLENE PINNOCK
<br /> ' "' Si nat ere
<br /> Z}�.ryo• I?9 S tg of Florida
<br /> _>�; MY February
<br /> 102118 9 cryo I) c
<br /> ?, �a€ EXPIRES:Febmery 13,2016 � er H/�/l l./
<br /> ,o,, ` Bande4ThWNderyPubbUnEenxlers Print of Type Commissioned Name
<br /> 4110
<br /> Personally Known ✓ OR Produced Identification
<br /> •
<br /> Type of Identification Produced
<br /> y�1v� KEITH end SCHNARS,P.A ,,,,_,y__,,,m,,, xa-,wav w.oxiwa.. am«,r,
<br /> Fowons5,igin AL FIRPAGE 40 RFQI2-04-02
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