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® 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 /> 0 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 /> ® 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 /> 0 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 /> 0 _ 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 /> I 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,CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> By
<br /> (Signa !/L/"
<br /> ' )
<br /> ® (Printed Name)G -f�- sfkrt4p
<br /> ® C 4 C7, ).4.,7"
<br /> ® (Title)
<br /> Sworn to and subscribed before me this .2 7 day of /117,41 , 20 /Z, by
<br /> ® (AFFIX NOTARY STAMP HERE)
<br /> / t
<br /> ® +•�y* Nenaida Fernandez Si Sig nature: Notary�- ublic—$tateofFlorida
<br /> 2enaida Fernandez PAa,tc� rime- 1
<br /> Mycan01n7 , a miss n E 157901
<br /> Sec E�9asPrint or Type Commissioned Name
<br /> ® Pe • _ '• •*n •- - ••uced Identification
<br /> ® Type of Identification Produced
<br /> louse 3 of 7
<br /> 0
<br /> • Curtis + Rogers Design Studio RFQ 12-04-02 56
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