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<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 entity, or an <br />affiliate of the entity bas been charged with and convicted of a public entity crime subsequent to July I, 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 entity, or an <br />affiliate of the entity bas been cb8rged with and convicted of a public elltity crime subsequent to July 1, 1989. <br />However, therl' has been a subsequent proceeding before a HearlDl Officer of the State of Florida, Division of <br />Administrative Hearings and the Final Order entered by the Hearing Officer of the State of Florida, Division of <br />Administrative Hearings and the Final Order entered by the Hearing Officer detennined that it was not in the <br />public interest to place the entity submitting this sworn statement on the convicted vendor list (Attach a copy <br />of the final order.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF TInS FORM TO THE CONTRACTING OFFICER FOR mE <br />PUBLIC ENTITY IDEt-! Ill'1&> IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, <br />THAT Tins FORM IS V ALlD THROUGH DECEMBER 31 OF THE CALENDAR. YEAR IN WInCH IT IS FILED. <br />I ALSO UNDERSTAND mAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING <br />INTO A CONTRACT IN EXCESS OF THE TIlRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA <br />STAnrrES. FOR CATEOORYTWO OF ANY, CHANGE IN THE INFORMATION CONT AlNED IN TIUS FORM. <br /> <br />00456 - 3 <br />