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<br />ATTACHMENT B <br /> <br />SWORN STATEMENT ON PUBLIC ENTITY CRIMES <br />SECTION 287.133 FLORIDA STATUTES <br /> <br />_ (2) This 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 the management of the entity, or <br />an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, <br />1989. <br /> <br />_ (3) 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 the management of the entity, or <br />an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, <br />1989, However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, <br />Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was <br />not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. <br />(attach a copy of the final order,) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTI NG OFFICER FOR THE PUBLIC ENTITY IDENTIFIED <br />IN PARAGRAPH 1 ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THATTHIS FORM IS VALID THROUGH DECEMBER 31 OF <br />THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY <br />PRI R TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, <br />FLO IDA STATUTES, FOR JEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. <br /> <br /> <br />William G. Benson, C.P.A. <br />(Printed or Typed Legal Name of Affiant <br /> <br />STATE OF FLORIDA ) <br />) SS: <br />COUNTY OF BROWARD ) <br /> <br /> <br />The foregoing Form was acknowledged before me this qi ~y of July 201 0, by William G. Benson, C.P.A., as Partner <br />of Keefe, McCullough & Co., LLP, a Florida corporation, on behalf of said corporation and limited partnership. He <br />personally appeared before me and is personally known to me. <br /> <br />{NOTARY SEAL} <br /> <br />Notary:~l) e ~JI~ <br /> <br />,,"'~'!-j:", BETH C. ANDERTON <br />i~~~t!'... ~~ Commission # DO 928845 <br />~~ Ii Expires October 1, 2013 <br />-"":,""; ,'<J;'/ Bonded 1JllU Troy Fain Insurance 800-385-7019 <br />'Ii,Rf"~" . <br /> <br />Print Name: <br /> <br /> <br />Notary Public, State of Florida <br />My Commission Expires: ID-{ <br /> <br />) J =j <br /> <br />1- <br />