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<br />- <br /> <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 entity. <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, or agents who are active in the management of the <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, or agents who are active in the management of the <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 REQUIRED 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 />Ti:. <br />Sworn to and subscribed before me this 1-' <br /> <br />Personally known 1J.or2.Mfh..l <;.. ~~wf <br /> <br />OR Produced Identification <br /> <br /> <br /> <br />day of D€C€"M ~ 12- <br /> <br />,20~. <br /> <br />Notary Public - State of ---F-o e...lbA <br />My commission expires S (+I-z.o(~ <br /> <br />(Type of Identification) <br /> <br />_0' PI1.,_ Notary Public Slate of Florida <br />~~ 'f- Mauncio Betancur <br />My CommisSIOn 00886076 <br />~~ .; <br />....,. f1' E)(oires 0510412013 <br /> <br /> <br />(Printed t <br />public) <br /> <br />20[2 <br />