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<br />I <br /> <br />I <br /> <br />term "person" includes those officers, directors, executives, partners, shareholders, employees, members, <br />and agents who are active in management of an entity. <br /> <br />I <br /> <br />6. <br /> <br />Based on the 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 />I <br /> <br />X Neither the entity submitting this sworn statement, nor any 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 />subsequentto July I, 1989. <br /> <br />I <br /> <br />I <br />I <br />I <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 management of the <br />entity, or an affiliate of the entity has been charged with and convicted of a public entity crime <br />subsequenttoJuly 1, 1989. <br /> <br />The entity submitting this sworn statement, or one of more of its officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the <br />entity, or an affiliate of the entity has been charged with and convicted of a public entity crime <br />subsequent to July I, 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 <br />by the hearing Officer determined that it was not in the public interest to place the entity <br />submitting this sworn statement on the convicted vendor list. (attach a copy of the final order) <br /> <br />I <br />I <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 PUBLIC <br />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 STATES FOR CATEGORY <br />TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN TillS FORM. <br /> <br />I <br /> <br />~reV7~ <br /> <br />I <br /> <br />I <br />I <br />I <br /> <br />Sworn to and subscribed before me this '2 \ day of ,tJ 0\JeM )o'er ,20 0,\ . <br /> <br />Personally known <br /> <br />x <br /> <br />OR produced identification <br /> <br />Notary Public - State of Florida <br />My Commission expires J 0 !I'l I 0 ~ <br /> <br />(Type of Identification) <br /> <br />I <br /> <br />I~ ~ S-..xl <br />;~ ~ i Wry" <br /> <br />~ ~ f' e"" I. <br /> <br />219 <br />7 1.'Q8 <br /> <br />~vo*k ~ <br /> <br />/ <br /> <br />Notary Public <br /> <br />I <br /> <br />(Printed typed or stamped Commissioned name of Notary Public) <br /> <br />I <br /> <br />I <br /> <br />~~ T=-C <br />~ _ J <br /> <br />TARGET ENGINEERING GROUP, INC, <br />