C3TS - Laserfiche WebLink

Home Browse Search

6. Based on information and belief, the statement which I have marked below is true in a relation to the entity submitting this sworn statement. (Please indicate which one (1) of the following three (3) statements is applicable.) x (1) Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. (2) The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. (3)The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. However, there has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor l'ist. (Attached is a copy of the final order.) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN P ARGRAPH I (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR THE CA TEGO Y TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS E Javier F. Salman. AlA. LEED AP (Printed or Typed Legal Name of Affiant) day of Ua LJ ,2010 by Jf6sicC\ ~f~ Notary's Name Printed, Stamped or Typed Notary Seal: Personally known: ( or Produced Identification \\,11"',// ,\\ ,.A p~ '" ...... _G.\~ o;;/ib_'" .:- _fbro"'-..... ..~ " ;:. '7"""" -'. ~ ~. .......:. : :.....=;:." .. : : : ..aD....: = - . ~ : - ~ .'. : ~ ,. ...... 4#' .... ..,;;~.........~.:- "~'!'tOF~\" "'''"',,\ Identification Produced