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<br />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 <br />relation to the entity submitting this sworn statement. [Indicate which statement applies] <br /> <br />V Neither the entity submitting this sworn statement, nor any of its officers, directors, <br />e~ves, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, nor any affiliate of the entity has been charged with and <br />convicted of a public entity crime subsequent to July 1, 1989. <br /> <br />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, nor any affiliate of the entity has been charged with and <br />convicted of a public entity crime subsequent to July 1, 1989. <br /> <br />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, nor any affiliate of the entity has been charged with and <br />convicted of a public entity crime subsequent to July 1, 1989. However, there has been a <br />subsequent proceeding before a Hearing Officer of the State of Florida, Division of <br />Adm inistrative Hearings and the Final Order entered by the Hearing Officer of the State of <br />Florida, Division of Administrative Hearings and the Final Order entered by the Hearing <br />Offic:er determined that it was not in the public interest to place the entity submitting this <br />sworn statement on the convicted vendor list. [attach a copy of the final order] <br /> <br />I UND~R_$TAN[)ItlA T.THE _SLJBMISSIQN OF THIS FORM TO THE CONTRACTING OFFICER FOR <br />THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY <br />ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN <br />WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC <br />ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT <br />PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE <br />IN THE INFORMATION CONTAINED IN THIS FORM. <br /> <br />It- GC.~ <br /> <br />[signature] <br /> <br />Sworn to and subscribed before me this -l c.; \-\r-... day of C?(;...:~,_~ <br /> <br /> <br />Personally known \ / <br />- <br /> <br />, 20.eJ. <br /> <br />'. <br />OR Produced identification <br /> <br />Notary Public - State of ~ lJ r- \. J c. <br /> <br />(Type of ide ntification) <br /> <br />M .. ~:li~:r~~., RYAN SPRADUN <br />Y commiSSion ex f~1:'~'E MYCOMMISSIOIUOD920502 <br />, ~" ,'~"<' EXPIRES: August 27, 2013 <br />"'~;:f..r.,~~" Bonded Thru Notary Public Underwriters <br />(rinte ped or st <br />commissioned name of notary public) <br /> <br /> <br />Form PUR 7068 (Rev. 06/11/92) <br /> <br />09/09 <br /> <br />00402-2 <br /> <br />03-4122.F <br />