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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 /> I 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 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 /> I
<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 /> 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 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 UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br /> PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1).1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br /> THAT THIS FORM IS VALID THROUGH DECEMBERJ31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
<br /> I ALSO UNDERSTAND THAT I AM REQUIRED TO IN RM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br /> A CONTRACT IN EXCESS OF THE THRESHOL n T PROVIDED IN SECTION 287.017, FLORIDA
<br /> STATUTES, FOR CATEGORY TWO OF ANY, CH'/%'/0Fil THE INFORMATION CONTAINED IN THIS FORM.
<br /> By: /
<br /> (Siggriatu •/
<br /> I Gr`Eg/Bati
<br /> (Psta /
<br /> rinted/Na e)
<br /> President /
<br /> (Title) c y //
<br /> I Sworn to and subscribed b�eefoore rrae this I day of • I 7.
<br /> , 20 ( , by
<br /> C�_ J Sh- r .
<br /> I (AFFIX NOTARY STAMP HERE)
<br /> I
<br /> NANpA QUINTANA Signature: Notary PubI - tate of Florida
<br /> e- NY CONNI890N
<br /> DD8013c w�a4 Do -4-
<br /> E olxrs 13 0 A°,',�, Print or Type Commissioned Name
<br /> l,yp}!AtA0.Y W�",,,„
<br /> IPersonally K =, • OR Produced Identification
<br /> Type of Identification Produced
<br /> i10/1998 3of7
<br />
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