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market value under an arm's length agreement, shall be a p6me facie w6v that one person
<br />controls another Nersom A person who knowingly enters into a joint venture with a person wnu
<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. r understand that a "person" as defines in Para. 257.133(1)(e), t+lutida Statutes, means any natural
<br />person or entity ornized under the laws of any state or uf 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 guvds 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 swum statement, nor any of it's officers, dire tors, 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 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 vt the entity has been rrharged with and convicted of a public entity crime subsequent to July 1,
<br />1989.
<br />The entity submitting this swom statement, or one or more of its officers, directors, executives, partnurs,
<br />shareholders, employees, members, or agents who are active in the management of the endq, or an
<br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1.
<br />1989. RYwever, there has been a subsequent proceeding before a Hearing Officer of the State of
<br />Flori'aa; Division of Administrative Hearings and the Final Order entered by tnc Hearing Officer of the
<br />State of Florida; Divisio,, U—f Admini5trativa 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 oi, the
<br />convicted vendor list. (Attach a copy of the final order.)
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM Tv THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOvt IS f•OR THAT PUBLIC ENTITY ONLY AND,
<br />THAT TRIS 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 THRESROLD AMOUNT PROVIDED IN SECTION 287.117, FLORIDA
<br />STA i U i t5, t -OR CA i EGORY TWO uF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br />By: C( T
<br />(signature)
<br />Aida M. Ct"tio
<br />(minted Nanm)
<br />Pr.enidErit.
<br />(Title)
<br />Swum to and aubaw ibed before me this Su -h day
<br />(AFFIX NOTARY STAMP
<br />,gyp "AN mmy puNc Suw a FWrWa
<br />pBaftM W=
<br />j4commmim rF 213353
<br />Personally Known A
<br />Type of Identification Produced
<br />.v,sw
<br />OR Produced IdentMcaWn
<br />3 of 7
<br />May , 24 i5 by
<br />Niz-
<br />ire_ ry Public — State of Florida
<br />or Type Commissioned Name
<br />
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