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Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn stat (Please in icate which statement applies) ement. Neither the entity submitting this sworn statement nor any officers, directors, executives, partners, shareholders, employees, members or agents who are active in management of the entity, nor any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this none or sworn statement, or more of the officers, directors, executives, Partners, shareholders ,employees, members or agents who are active in management of the entity, or an affiliate of the entity has been charged with and convicted of a Public entity crime subsequent to July 1, 1989, and (Please indicate which additional statement applies) there has been a proceeding concerning the conviction before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer did not Place the person or affiliate on the convicted vendor list. (please attach copy of final order). the person or affiliate was placed on the convicted vender list. There has been a subsequent Proceeding before a hearing officer determined that It was in the public interest to remove the person or affiliate from the convicted vendor list. (Please attach copy of final order.) the Person or affilia has not been pia ed on 'cr the convicted vendor list . de s b a&s y, or pending with, the Dep(rtment of Gen ralc5i "v'ces)n Signed state of: F)or,dG Date: County of Dr, C1e PERSONALLY APPEARED BEFORE ME, the undersigned authority, VGr6er who after. first being sworn by me. of f i•ed his: her signature in the space day of JQvnvotH •"•r Cort:m!ssion Expires: 'rae of Identification produced: 19' VSonc,I1. Ka.o� J or Provided above, on this 1998 Notary bu b!ic SW of FL pro EON AisUC 3,104 Personally known Page 8