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<br />6. Bascd on information and bclicC thc statcmcnt which I havc markcd bclow is truc in a <br />rclation to thc cntity submitting this sworn statcmcnt. (Pleasc indicatc which onc (1) ofthc <br />following thrcc (3) statcmcnts is applicablc.) <br /> <br />~ (1) Ncithcr thc cntity submitting this sworn statcmcnt, nor any of its otTiccrs, dircctors, <br />cxccutivcs, partncrs, sharcholdcrs, cmployccs, mcmbcrs, or agcnts who arc activc in thc <br />managcmcnt of thc cntity, or any affiliatc of thc cntity has bccn chargcd with and convictcd of <br />a public cntity crimc within thc past 36 months. <br /> <br />_(2) Thc cntity submitting this sworn statcmcnt, or onc or morc of its officcrs, dircctors, <br />cxccutivcs, partncrs, sharcholdcrs, cmployccs, mcmbcrs, or agcnts who arc activc in thc <br />managcmcnt of thc cntity, or any affiliatc of thc cntity has bccn chargcd with and convictcd of <br />a public cntity crimc within thc past 36 months. <br /> <br />_(3) Thc cntity submitting this sworn statcmcnt, or onc or morc of its officcrs, dircctors, <br />cxccutivcs, partncrs, sharcholdcrs, cmployccs, mcmbcrs, or agcnts who arc activc in thc <br />managcmcnt ofthc cntity, or agcnts who arc activc in managcmcnt ofthc cntity, or any affiliatc <br />of thc cntity has bccn chargcd with and convictcd of a public cntity crimc within thc past 36 <br />months. Howcvcr, thcrc has bccn a subscqucnt procccding bcforc a Hcaring Officcrs of thc <br />Statc of Florida, Division of Administrativc Hcarings and thc Final Ordcr by thc Hcaring <br />Olliccr dctcrmincd that it was not in thc public intcrcst to placc thc cntity submitting this sworn <br />statcmcnt on thc convictcd vcndor list. (Attachcd is a copy ofthc final ordcr.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS <br />FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH <br />DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE <br />PERIOD OF THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I <br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY <br />PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD <br />AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR THE <br />CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS <br />FORM. <br /> <br /> <br />Statc of Florida <br /> <br />County of Miami - Dade <br /> <br />Sworn to and subscribcd bcforc mc this cR--S <br /> <br />~C?l& <br /> <br />Notary's Namc Printcd, Stampcd or Typcd <br /> <br />Pcrsonally Known: <br /> <br />01 Produccd Idcntification <br /> <br />Idcntification Produccd <br /> <br />Jorge Ferrer <br />(Printcd or Typcd Lcgal Namc of Affiant) <br /> <br />day of ~ <br /> <br />,2010 by <br /> <br />Notary Scal: <br /> <br />........................: <br />"...........N..'.N.A, WHITE : <br />741 : <br />"""'/{" comm# DD0815 : <br />,;:""~'~ Pti'~ : <br />{C;:~~;~ Expires 11/21/2012 : <br /> <br />'<;~'/'?:.(;l..! Florida Notary Assn" loc .~ <br />-....j..~j;:',.. .~~\'\~. _~ ~ 111".1.1. 1....1......" 111. I'" III. <br />