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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 /> Q has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br /> o 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 /> O 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 /> o services let by a public entity, or which otherwise transacts or applies to transact business with a public
<br /> O 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 /> O 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 /> Q shareholders, employees, members, or agents who are active in the management of the entity, nor any
<br /> O affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br /> 1989.
<br /> O
<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 /> o 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 /> O 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 /> O 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 /> O 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 /> n. ure)
<br /> $ ngram.P.E.
<br /> (Printed Name)
<br /> Senior Vice President/Principal Associate
<br /> o (Title)
<br /> O Sworn to and subscribed before me this 30th day of April , 20 12 , by
<br /> O Jerry Ingram,P.E.
<br /> Oo MY COMMISSION a EE1617o9 Signature: Notary Public —State/off Florida
<br /> > Y,� EXPIRES January 19,2016 `7J�,/yyylL .5 c,3r/O the
<br /> b
<br /> Print or Typ6 Commissioned Name
<br /> O Personally Known X OR Produced Identification
<br /> Q Type of Identification Produced
<br /> O 1011998 3 of 7
<br /> O
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