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<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 />__X-_ (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 />SIGNATURE OF AFFIANT
<br />I
<br />
<br />Julio E. Alvarez, PE
<br />(Printed or Typed Legal Name of Affiant)
<br />
<br />State of Florida County of Miami-Dade
<br />Sworn to ,,\nd sub"scribed ~efore me this ___8th __ day of October ,2007 by
<br />
<br />I ~V' ,
<br />--~j~--~~~~~\;---------------------------------------------------.
<br />
<br />_t-.-1-.:.._L~',L,~S!l,...:>." ~y____________________________ Notary Seal:
<br />Notary's Name Printed, Stamped or Typed
<br />
<br />Personally Known: ___..1-____ or Produced Identification ____
<br />
<br />';;~;~';:':'~~:" N. Lavelaild
<br />~.~., @'~:~:(lrili1\iss;o~ # DD359557
<br />~'~"s~.'~:l:.Xpiies; r-;vV. 08, 2008
<br />-,;;-,'oi'i<d':.,'- Bonded Thr~
<br />"'IIJlII\\\"> .;tlailtic BIJnding Co,) Inc.
<br />
<br />Identification Produced
<br />
<br />~
<br />
<br />Wolfberg Alvarez & Team
<br />City of Sunny Isles Beach
<br />October 10, 2007
<br />
<br />Page 14
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