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<br />5. I understand that a "person" as defined in Paragraph 287.133(1)(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 entit)'. <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 />/" Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, <br />partners, shareholders, employees, members, 0 r a gents w ho are active in the management 0 f t he <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, 0 r a gents w ho are active i n the management 0 f t he <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 REQillRED 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 STATUTES FOR CATEGORY TWO OF ANY <br />CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. <br /> <br />/) / <br />/ / I <br />~, V ," <br />/ifyJ11ftd//l.4Lc:d:?tAV <br /> <br />(Signature) <br /> <br />Sworn to and subscribed before me this <br />/ <br /> <br />II~ <br /> <br /> <br /> <br />day of <br /> <br />N oVenlber <br /> <br />,200S. <br /> <br />Personally known <br /> <br />OR Produced Identification <br /> <br />Notary Public - State of FiOl'"idtt <br />My commission expires :::::r",) I ~ d Lt I dOO If <br /> <br />(Type of Identification) <br /> <br />~~ ':'~ IA~ <br /> <br />(Printed typed or stamp commIssIoned name of notary <br />public) <br /> <br />",..flV puQ. OFFICIAL NOTAAY SEAL <br />o ~ PRISCILlA TYLER WAlKER <br />~~i("\ <br />r; ,>1-. ~ COMMISSION NUMBER <br />~ ~ 00133748 <br />(:' 0 oq:. MY COMMISSION EXPIRES <br />F F\. JUL Y 24,2006 <br /> <br />20f2 <br />