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<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. {indicate which statement applies.} <br /> <br />X Neither 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 entity, <br />nor any affiliate of the entity has been charged Witll and convicted of a public entity crime subsequent to <br />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 entity, or <br />an affiliate of tlle entity has been charged Witll and convicted of a public entity crime subsequent to July <br />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 entity, or <br />an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July <br />1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of <br />FIOIida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer <br />determined that it was not in the public interest to place the entity submitting this sworn statement on the <br />convicted vendor list. {attach 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 THAT <br />PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE <br />CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO <br />INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE <br />THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR <br />CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. <br /> <br />^~~~/ <br /> <br />{signature l <br /> <br />// "'- ::;-- 67 <br /> <br />{date} <br /> <br />PERSONALLY APPEARED BEFORE ME, the undersigned authority, Gary Stankovich who, <br />after first being sworn by me, affixed his/her signature in the space provided above on this 5"f-?t. th day <br />of November, 2007 <br /> <br />- - <br /> <br />Attest: .~&I!CL )f~~ <br />Notary Public <br /> <br />My commission expires: {) et: :z, d oQf <br />/ <br /> <br />(Notary Seal) <br /> <br />4 a MU>>.l.l1RaIAS <br />, COmmIIIIon" 1617457 <br />,. NoIarv N*c . CaIIfomla <br />'~Cowttv <br />MvComm. ExpnaOct 2,2008 <br /> <br />SOLI D () RESOURCES <br /> <br />E:.VlI'O'<J>lE'o"TAL..... E\lEl\GENCY Sm\T-fS <br /> <br />36 <br />