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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 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 /> ®
<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 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 /> ® 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, CHA ��THE INFORMATION CONTAINED IN THIS FORM.
<br /> ® By: `ij
<br /> ® (Signature
<br /> Manuel Synaiovski
<br /> (tl (Printed Name)
<br /> ® Menacing Princlual
<br /> (Title)
<br /> 4110
<br /> ® ' A GSvutp and subscribed me this `3 day of D( J1 . 20 \Z , by
<br /> ® `te,g(lltuttph�7"1 \l' e.Mg6
<br /> aL—
<br /> ® ( .kp,.Y�S'TAMP HERE)
<br /> s N/409Q'' SSION64% ty
<br /> 6 ,09,2p/f%..*_ Signature: Not ry Public—State of Florida
<br /> (� = z �� C. MG r,�
<br /> ® *: .... o_ Print or Type Commissioned Name
<br /> ® '4v��t h N�j , q , ✓ OR Produced Identification
<br /> ® T �4°r t si Mmie•`.
<br /> ® yp iuAnttfZation Produced y\ I A
<br /> 10/1998 3of7
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<br /> Fl
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