Laserfiche WebLink
<br />. <br /> <br />. <br /> <br />. <br /> <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 />.~~~j <br /> <br />SIGNATUI~E OF AFFIANT (Printed or Typed Legal Name of Affiant) <br /> <br />State of '1~ County of 7~ -0~ LltJ-- J. _ <br />Sworn to and subscribed before me this "ft.< ~--tI. day of tr ~ , 2007 by <br /> <br />Paul Reinarman, Principal <br /> <br />MAi2..ir9 Ct. P1T-e.ISTAltJ-{]I<ui?- <br />Notary's Name Printed, Stamped or Typed <br /> <br />Notary Seal: <br /> <br />"'"'''''' Man'a C Atristain-Cruz <br />,,~y PiJ " . <br />~~";b"~~~Commission #00551344 <br />~~".~.:~~Expires: MAY 11,2010 <br />,V'J': ....ol:f... <br />'",;OF~",' www A'RONNOTARV.COi\ \ <br />""n' . .~ _ '~ <br /> <br />Personally Known: <br /> <br />/" <br /> <br />or Produced Identification <br /> <br />Identification Produced <br /> <br />