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Imarket 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 /> I 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 /> Iperson 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 /> I 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 /> Isubmitting 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 /> I 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 /> X 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 /> I 1989.
<br /> X The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> I
<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 /> I 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 I UNDERSTAND THAT THE SUBMISSION • HIS F•RM TO THE CONTRACTING OFFICER FOR THE
<br /> PUBLIC ENTITY IDENTIFIED IN PARAG-: -H 1.1 (ON: ABOVE IS FO' -AT PUBLIC ENTITY ONLY AND,
<br /> THAT THIS FORM IS VALID THROUG `P - • :� • ER 3 OF THE C• DAR YEAR IN WHICH IT IS FILED. I
<br /> 1 ALSO UNDERSTAND THAT I AM REQ T ►1 / • INF•RM TH ` BLIC ENTITY PRIOR TO ENTERING INTO
<br /> A CONTRACT IN EXCESS OF THE 4 :gre . AMO • PROVIDED IN SECTION 287.017, FLORIDA
<br /> STATUTES, FOR CATEGORY TWO O' •i �;�'G ' THE INFORMATION CONTAINED IN THIS FORM.
<br /> By: .it
<br /> (S'.n.T da
<br /> (Pri -d [lame)
<br /> esidden •
<br /> (T r
<br /> Sworn to and subscribed before me this I day of ` , , 20 Ft' , by
<br /> l
<br /> 1 (AFFIX NOTARY STAMP HERE)
<br /> UINTAN Signatu -• .'- . ic—State of Florida
<br /> W OD A Q �q ooso' - 7 jarla
<br /> M�'C0�111ISS10•
<br /> �.R{AFS'.)uH}�.:Assoc Co. �.��
<br /> v ,, Print o :mmissioned Name
<br /> Personally • mss'• OR Produced Identification
<br /> 1 Type of Identification Produced
<br /> I10/1998 3of7
<br />
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