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O
<br /> O
<br /> O 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 /> O considered an affiliate.
<br /> O 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 /> O X Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners,
<br /> O 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 /> O The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> O shareholders, employees, members, or agents who are active in the management of the entity, or an
<br /> 0 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 /> O shareholders, employees, members, or agents who are active in the management of the entity, or an
<br /> O 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 /> O 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 PARA - . ' . 11.1 (ONE)AB I'VE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br /> O THAT THIS FORM IS VALID THROU DEC ' BER 31 OF E CALE PAR YEAR IN WHICH IT IS FILED. I
<br /> • ALSO UNDERSTAND THAT I AM R.•UIRED • NFORM E P BLit NTITY PRIOR TO ENTERING INTO
<br /> A CONTRACT IN EXCESS OF T THRES '10 D AMO 7'OV D' D IN SECTION 287.017, FLORIDA
<br /> O STATUTES, FOR CATEGORY TW• OF ANY, it- ? ,c / :,:i-4 'TION CONTAINED IN THIS FORM.
<br /> ® By Il//A_..,
<br /> (Signatur:�
<br /> • Francisco Costova, Jr., R.A., A.I.A., NCARB
<br /> O (Printed Name)
<br /> President/Owner
<br /> O (Title)
<br /> O Sworn to and subscriped before me this 30 day of April , 20 12 , by
<br /> • Fit 44 C LS Cc.,5'fci) -IA- . �
<br /> • (AFFIX NOTARY STAMP HERE) L- � �
<br /> • NOTARY PUBLIC-STATE OF FLORIDA
<br /> " •• Jay C. Evans Signatur • blic—State of Florida
<br /> ® •
<br /> p�_$r Commission#DU795436
<br /> •••`�'.'' Expires: JULY 08,2012 Print or Type Commissioned Name
<br /> O BONDED IliktU ATL1NTIC BONDLNG CO,6C
<br /> • Personally Known X OR Produced Identification
<br /> • Type of Identification Produced
<br /> • 10/1998 3 of 7
<br /> 56
<br /> O
<br /> •
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