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<br />i--
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<br />
<br />transact business with a public entity. The term "persons" includes those officers, directors,
<br />executives, partners, shareholders, employees, members, and agents who are active in
<br />management of any entity.
<br />
<br />11.6. Based on information and belief, the statement which I have marked below is true in relation to
<br />the entity submitting this sworn statement. (Indicate which statement applies.)
<br />
<br />x
<br />
<br />Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of
<br />the entity, nor any affiliate of the entity has been charged with and convicted of a public entity
<br />crime 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, or agents who are active in the management of
<br />the entity, or an affiliate of the entity has been charged with and convicted of a public entity
<br />crime 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, or agents who are active in the management of
<br />the entity, or an affiliate of the entity has been charged with and convicted of a public entity
<br />crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a
<br />Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order
<br />entered by the Hearing Officer of the State of Florida, Division of Administrative Hearings and the
<br />Final Order entered by the Hearing Officer determined that it was not in the public interest to
<br />place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of
<br />the final order.)
<br />
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY
<br />AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS
<br />FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO
<br />ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION
<br />287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANYr-GHANGE-IN-THE INFORMATION
<br />CONTAINED IN THIS FORM. ~ /)
<br />
<br />By: ( ~
<br />\"- . ~ --------
<br />
<br />(Signature)
<br />HAMID FOULADI
<br />
<br />(Printed Name)
<br />PRESIDENT
<br />
<br />(Title)
<br />
<br />SWpl]1 to and s,l,lbscribed before rw= ~his
<br />/:t.9421A'g --FO {} L G QN
<br />
<br />(AFFIX NOTARY STAMP HERE
<br />
<br />1 day of
<br />
<br />
<br />_,I"V";""
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<br />. i ~~;;",;-;,~~:
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<br />
<br />MARIA LILIANA LATlEGUE
<br />MY COMMISSION # DD 638227
<br />EXPIRES: June 9, 2011
<br />Bonded Thru Notary Public Underwriters
<br />
<br />Personally Known OR Produced Identification
<br />Type of Identification Produced
<br />
<br />END OF SECTION
<br />
<br />PAGE 61 OF 130
<br />8lD No. 08-10-01
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