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<br />5. I understand that a "person" as defined in Paragraph 287. I33(I)(e), Florida Statutes, means any <br />natural person or entity organized under the laws of any state or of the United States within the legal <br />power to enter into a binding contact and which bids or applies to bid on contracts for the provision <br />of goods or services let by a public entity, or which otherwise transacts or applies to transact business <br />with a public entity. The term "person" includes those officers, executives, partners, shareholders, <br />employees, members, and agents who are active in management of an entity. <br /> <br />6. Based on information and belief, the statement which I have marked below is true in relation to the <br />entity submitting this sworn statement. (Please indicate which statement applies.) <br /> <br />LNeither the entity submitting this sworn statement, nor any of its officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the <br />entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime <br />subsequent to July 1, 1989. <br /> <br />_The entity submitting this sworn statement, or one or more of its officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the <br />entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime <br />subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing <br />Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by <br />the Hearing Officer determined that it was not in the public interest to place the entity submitting <br />this sworn statement on the convicted vendor list. (attach a copy of the final order). <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR <br />THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC <br />ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR <br />YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THAT <br />PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD <br />AMOUNT PROVIDED IN SECTION 287.017 FLORIDA STATUTE FOR CATEGORY TWO OF ANY <br />CHANGE IN THE INFORMATION CONTAINED IN THIS FORM <br /> <br /> <br />Sworn to and subscribed before me this J,ZO'lh. <br /> <br />day of <br /> <br />N 0 w'V'i'-b-e,l.\/ <br /> <br />, 20...21-. <br /> <br />Personally known <br /> <br />v""'~ <br /> <br />OR Produced Identification <br /> <br />Notary Public - State of <br />My commission expires <br /> <br />p <br />. L <br /> <br />(Type of Identification) <br /> <br />6/13)05 <br />I " <br /> <br />~~.f\i~~4:' ...- <br /> <br />(Printed typed or stamped commissioned ffame' oC.n'ota'~1'. <br />public) , '.' /." 'i" <br /> <br />~o..,.,...~ Jane Nberta Hines ' . "':, <br />~ c~ ; My Commission D0024848 <br />"? 0, ,..,o~ Expires May 13. 2005 <br /> <br />20f2 <br />