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6, BaseJ on informalion and belief: the statement which I have marked belm, is true in a relation to the entit) submitting this sworn statement. (Please indil:all: which one (I) of lhe following three (3) statements i::. applicable,) ~ (I) Neither the enlit) submitting this Sworn statement. nor an) of ilS otlicers. directors, executives, partner::., shareholders, employees. members. or agent~ who an: active ill thl: management of the entit). or any affiliate of the entily has oeen charged wilh and convicted of a puolic entity crime \\ithin the past 36 months, _(2) The entit) submilting this sworn statement. or one or more of its officers. directors, executives. partners, shareholders, employees. members, or agents who arc active in the management of the emity, or any affiliatc of the emit)' has been charged with and convicted of a public entit) crime within the past 36 months, _(3) The elllit) suomitting this sworn statement. or one or more of it:, ofTicers. directors. executivcs. partners. shareholders. cmployees, members. or agents who arc active in the management of the entity, or agents who are active in rmll1agement of the entity, or any affiliate or the emit) has becn charged with and convicted of a public emit) crimc within the past 36 months, 1[0\\ cver. there has been a subsequent proceeding before a Hearing Officers of the State of Florida. Division of Administrative Hearings and thc Final Order by the Hearing Otlicer detennined that it "as not in the public interest to place the entit) submitting this s\\orn statement on the convicted vendor list. (Attached is a COP) of the final order.) I UNDERSTAND TIIA T TilE SUBMISSION OF TIllS FORM TO THE CONTRACTING OFFICER FOR TilE PUBLIC ENTITY IDENTIFIED IN PARAGRAPII I (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONI.Y AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF TilE CALENDAR YEAR I]\; WHICH IT IS FILED AND FOR THE PERIOD 01' TIll:. CONTRACT ENTERED INTO, WIIICHEVER PERIOD IS LONGER, I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PlJRl.IC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF TilE TIIRESHOLD AMOUNT PROVIDED IN SECTION 287,017, FLORIDA STATUTES FOR THE ~ATEGORY TWO ~F ANY C1IANGE IN TilE INFORMATION CONTA[NED IN THIS I.ORM, I, C "? I Edwin Mojena, PE FAFjANT (Printed or Typed Legal Name or Amant) (~ t f Broward olin v 0 -- Sworn to and subscribed before me this 24th da) of May SIG , 20 I 0 b~ Edwin Mojena Mary Ann Padro Notary's Name Printed, Stamped or Type Personall~ KnU\\ll: X or Produced IJentiliealioll Notary Seal: Identification Produced .1................ MARY AN;~;pADRO..........: ""\~'~IUJII, . k~)f-"P!it:'% Comm# 000859742 : ...-to' ~~- . %;~ .~} Expires 2/612012 E ....."fl&'f.~~\\:..,~' Fbrida Notary Assn Inc : . II... ...... ~ ........ It' 'I. '" II'.... t':.. ",;