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® .
<br /> ® market value under an arm's length agreement, shall be a prime facie case that one person
<br /> ® - controls another person. A person whb 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 /> ®
<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 /> ® _ The entity submitting this swom 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 /> O _ 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 /> ® 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,
<br /> { �
<br /> CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> ® By: / r,,
<br /> ® (Signature) 4�
<br /> Adriana Savino-Miller
<br /> ® (Printed Name)
<br /> President
<br /> ® (Title)
<br /> 0 Sworn to and subscribed before/7 this 9th day of APnl , 201
<br /> o 44Anf . a27&t b- /22,n,
<br /> ® . (AFFIX NOTARY STAMP HERE) • 4 �9
<br /> ® 1 4. CRISTIANA GRULLON 1 Signature: Notary Public State of Florida
<br /> ® 1 . 1 n. Notary Public•State of Florida I CR'GA 1 t3 n N CP-u t Ilnr
<br /> ® , �� e. My Comm.Expires Aug 26.2015 I Print or Type Commissioned Name
<br /> ( '•„o�.�d,.'�• Commission I EE 100586 I
<br /> ® Personally tification
<br /> ® Type of Identification Produced FL refu N 410-007-cb-S16-O
<br /> 0 1011998 3 of 7
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