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(07-10-01) Prof. Svcs. for Emergency Debris Disposal Mgmt.
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RAS Construction
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Last modified
7/16/2010 4:23:58 PM
Creation date
8/14/2008 1:13:53 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. Svcs. for Emergency Debris Disposal Mgmt.
Bid No. (xx-xx-xx)
07-10-01
Project Type (Bid, RFP, RFQ)
RFQ
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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 FORM. <br /> <br />-::s:J2 /J ^ ~~oeL '\2.cJv~e2.- <br />-<.....s.IG.f'~~ OF AFFIANT (Printed or Typed Legal Name of Affiant) <br /> <br />State of (l D r t' e-L County of ~{i ~yq i Ot-4LL <br />Sworn to and subscribed before me this /3 day of tJ b Ii t rV\.~r <br /> <br />.:rt.HL~ rLo J.. r: c ~. <br /> <br />Ii (, ~t C; LA ~ v' c---{1- <br /> <br />Notary's Name Printed, Stamped or Type <br /> <br />Personally Known: -.Lor Produced Identification _ <br /> <br />, 2007 by <br /> <br /> <br />Notary Seal: <br /> <br />$~'$...~.'~~,:,,__ Aliet Guevara <br />€~{Ah'.;.cnMM'SS'ON #DD651761 <br />-'!\' .~. <br />\,,:~ .... ';f'; EXPIRES: MAR. 18,2011 <br />~",,~,r..~"" www.AARONNarARY.com <br /> <br />Identification Produced <br />
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