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•
<br /> •
<br /> •
<br /> • . •
<br /> • market 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 /> • 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 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 /> • 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 /> • affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br /> 1989.
<br /> •
<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,
<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 /> •
<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, IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> •
<br /> • By. tee-
<br /> (Signature)
<br /> • Tony Shahnami,PE,CxA,FE,CES,CHS-III
<br /> • (Printed Name)
<br /> 5GM President
<br /> • (Title) nn
<br /> • wom jo and subscribed before me this 4pt,,/day of ll// 20/ ,by
<br /> • 'My ih&bnarh
<br /> LAURIE STRANGIE 1{..,,__��
<br /> ®
<br /> (AF FI,, , ,:...YATPW? 011411 UrrdUjaC-C4
<br /> STATE OF FLORIDA
<br /> ® Comm*EE141665 Signat re: Notary P tic—State of Florida
<br /> •,� Expires 11/13/2015 [ ((U/-IC Fa t?�,
<br /> • Print or Type Commissioned ame
<br /> • Personally Known (/ OR Produced Identification
<br /> ® Type of Identification Produced
<br /> • 10119913 3017
<br /> •
<br /> ® 68
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