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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 /> • 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 /> l• 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, CHANGE
<br /> 619
<br /> INTHE INFORMATION CONTAINED IN THIS FORM.
<br /> • By: 0 di i I I il �1
<br /> ( nature)
<br /> • Kathryn • _:ry Richa s
<br /> (Printed Name)
<br /> • President
<br /> • (Title)
<br /> • /�� Sworn to and subscribed before me this�3 day of .4i-. /if / , 20 /2 , by
<br /> ® K�rr n "Zerliy ;Z.'ci(lrs/-4 •
<br /> Si.• (AFFIX QIARY SIAMPaHbR5J — — — — /
<br /> ® ,..o„,' GERARDO E.DELANEY
<br /> :R -'`;\ Notary Public -Slate of Florida Signature: Notary Public—State of Florida
<br /> ® -• •, E My Comm. Expires Sep 17.2014 66,E-536/
<br /> 1C-4....-",,,,,,, commission it EE 25361 Print or Type Commissioned Name
<br /> • '%% —cone-tmom; `::conal Notary Assn.
<br /> ® Persona IyT(nown OR Produced Identification i-----
<br /> Type of Identification Produced 7 Pr r
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<br /> ® torose 3 of 7
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