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<br />6. Based on information and belief, the statement which I have marked below is true in a relation
<br />to the entity submitting this sworn statement. (Please indicate which one (1) of the following
<br />three (3) statements is applicable.)
<br />
<br />~ (1) Neither the entity submitting this sworn statement, nor any of its officers, directors,
<br />executives, partners, shareholders, employees, members, or agents who are active in the
<br />management of the entity, or any affiliate of the entity has been charged with and convicted of a
<br />public entity crime within the past 36 months.
<br />
<br />(2) The entity submitting this sworn statement, or one or more of its officers, directors,
<br />executives, partners, shareholders, employees, members, or agents who are active in the
<br />management of the entity, or any affiliate of the entity has been charged with and convicted of a
<br />public entity crime within the past 36 months.
<br />
<br />(3) The entity submitting this sworn statement, or one or more of its officers, directors,
<br />executives, partners, shareholders, employees, members, or agents who are active in the
<br />management of the entity, or agents who are active in management of the entity, or any affiliate of
<br />the entity has been charged with and convicted of a public entity crime within the past 36 months.
<br />However, there has been a subsequent proceeding before a Hearing Officers of the State of
<br />Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer determined
<br />that it was not in the public interest to place the entity submitting this sworn statement on the
<br />convicted vendor list. (Attached is a copy of the final order.)
<br />
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER
<br />FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THE PUBLIC
<br />ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE
<br />CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT
<br />ENTERED INTO , WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM
<br />REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN
<br />EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED
<br />IN THIS fOR,!Y1. ('I
<br />Vi' 'j- .
<br />(1M ~i0J'ho/j Paul Reinarman, Principal
<br />SldNAfui E OF AFFrANT (Printed or Typed Legal Name of Affiant)
<br />,
<br />
<br />State of '~/Lv~<2r Countyof 7u-~~ -0~ LIt!- ,1 _
<br />Sworn to and subscribed before me this /u '.u..t.--u!. day of tr ~ , 2007 by
<br />
<br />fv1/l i?.. i f1 CI. H, ~ j S T A I ,J - {] ;< J ~
<br />Notary's Name Printed, Stamped or Typed
<br />
<br />Personally Known:
<br />
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<br />
<br />or Produced Identification
<br />
<br />Notary Seal:
<br />
<br />",,,//,,,, Man'a C Atristain-Cruz
<br />"~YPlJ" .
<br />l?)";;&"~~~~Commission #00551344
<br />~~'..A.:~~Expires: MAY 11,2010
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<br />'",;OF~\," WWW^'R.ONNOTARv.con;i"'\(
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<br />Identification Produced
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