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�I <br />,.Tay <br />includes those officers, directors, executives, partners, shareholders, employees, members, <br />and agents who are active in management of an entity. <br />6. Based on information and belief, the statement which I have marked below is true in <br />relation to the entity submitting this sworn statement. (Indicate which statement applies] <br />X� Neither the entity submitting this sworn statement, nor any of its officers, <br />directors, executives, partners, shareholders, employees, members, or agents who are <br />active in the management of the entity, nor any affiliate of the entity has been charged <br />with and convicted of a public entity crime subsequent to July 1, 1 989. <br />The entity submitting this sworn statement, or one or more of its officers, <br />directors, executives, partners, shareholders, employees, members, or agents who are <br />active in the management of the entity, nor any affiliate of the entity has been charged <br />with and convicted of a public entity crime subsequent to July 1, 1 989. <br />The entity submitting this sworn statement, or one or more of its officers, <br />directors, executives, partners, shareholders, employees, members, or agents who are <br />active in the management of the entity, nor any affiliate of the entity has been charged <br />with and convicted of a public entity crime subsequent to July 1 , 1989. However, there <br />has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division <br />of Administrative Hearings and the Final Order entered by the Hearing Officer of the State <br />of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing <br />Officer determined that it was not in the public interest to place the entity submitting this <br />sworn statement on the convicted vendor list. [attach a copy of the final order] <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 ENTITY <br />ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN <br />WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC <br />ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT <br />PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE <br />IN THE INFORMATION CONTAINED IN THIS FORM. <br />Sworn to and subscribed before me this <br />Personally known X <br />OR Produced identification <br />(Type of identification) <br />30 <br />V-P 1 6r dy k' c�111en <br />Corilinission ;! DD3314 -02 <br />=ny Ex;,ires: APR. 29 2010 <br />Co., Inc. <br />Form PUB 7068 (Rev. 06/11/92) <br />March 2007 <br />[signature] <br />day of April 2007 . <br />Notary Public - State of Florida <br />00402 -2 <br />My commission expires 4 -29 -2010 <br />Kimberly A Callen <br />(Printed typed or stamped <br />commissioned name of notary public) <br />03 -4122. C <br />'f "_ni <br />