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<br />6. Based on information and belief, the statement which I have marked below is true in relation to <br />the Person submitting this sworn statement. (Indicate which statement applies.) <br /> <br />X (1) Neither the Person submitting this sworn statement, nor any officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the <br />Person, nor any Affiliate of the Person has been charged with and convicted of a public entity crime <br />subsequent to July 1, 1989. <br /> <br />_ (2) The Person submitting this sworn statement, or one or more of its officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in management of <br />the Person, or an Affiliate of the Person has been charged with and convicted of a public entity crime <br />subsequent to July 1, 1989. <br /> <br />_ (3) The Person 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 management <br />of the Person, or an Affiliate of the Person has been charged with and convicted of a public entity <br />crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing <br />Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by <br />the Hearing Officer determined that it was not in the public interest to place the Person submitting <br />this sworn statement on the convicted vendor list. (attach a copy of the final order) <br /> <br />THE UNDERSIGNED UNDERSTANDS AND ACKNOWLEDGES THAT THE SUBMISSION OF <br />THIS FORM TO MDX IS FOR MDX ONLY AND THAT THIS FORM IS VALID THROUGH <br />DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED WITH MDX. I ALSO <br />UNDERST AND THAT I AM REQUIRED TO INFORM MDX PRIOR TO ENTERING INTO ANY <br />CONTRACT WITH MDX OF ANY CHANGE IN THE INFORMA nON CONTAINED IN THIS <br />FORM. <br /> <br /><tZU-IS. ~/~ <br /> <br />SIGNATURE OF AFFIANT <br /> <br />Robert B. Deuser <br />(Printed or Typed Legal Name of Affiant) <br /> <br />State of Florida County of Broward <br /> <br />Sworn to and subscribed before me this 18th day of <br /> <br />May <br /> <br />, 20 lQ by <br /> <br />Robert B. Deuser, Vice President <br /> <br />Linda S. Scotece ~jAY /J ",--Cfdu.~- <br />Notary's Name Printed, Stamped or Typed <br /> <br />Notary Sea ....rif.trU.... L1NDAS.SCOTECE <br />l:rK~~ MY COMMISSION # DD 711648 <br />~'~'~l EXPIRES: December 13,2011 <br />"1..l/r"FjI~'< Bonded Thru Notary Public Underwriters <br /> <br />Personally Known: <br /> <br />x <br /> <br />or Produced Identification <br />