Laserfiche WebLink
<br />6. Based on information and belief, the statement which I have marked below is true in a relation to <br />the entity submitting this sworn statement. (Please indicate which one (1) of the following three <br />(3) statements is applicable.) <br /> <br />~ (1) Neither the entity submitting this sworn statement, nor any of its officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in the management <br />of the entity, or any at1iliate of the entity has been charged with and convicted of a public entity <br />crime within the past 36 months. <br /> <br />_(2) The entity submitting this sworn statement, or one or more of its ot1icers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in the management <br />of the entity, or any affiliate of the entity has been charged with and convicted of a public entity <br />crime within the past 36 months. <br /> <br />_(3) The entity 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 entity, or agents who are active in management of the entity, or any at1iliate of the entity has <br />been charged with and convicted of a public entity crime within the past 36 months. However, there <br />has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of <br />Administrative Hearings and the Final Order by the Hearing Officer determined that it was not in the <br />public interest to place the entity submitting this sworn statement on the convicted vendor list. <br />(Attached is a copy of the final order.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR <br />THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 <br />OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE <br />CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND <br />THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A <br />CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, <br />FLORIDA STATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE <br />INFORMATION CONTAINED IN THIS FORM. <br /> <br />YlutR- o. ~ <br />SIGNATURE OFu\' FIANT <br /> <br />Ivette O. Argudin <br />(Printed or Typed Legal Name of Affiant) <br /> <br />State of FL County of Miami-Dade <br />Sworn to and subscribed before me this 25th day of <br /> <br />May <br /> <br />, 2010 by <br /> <br />Ivette O. Argudin <br /> <br />Wendy Gomez <br />Notary's Name Printed, Stamped or Typed <br /> <br />Notary Seal: <br /> <br />Personally Known: <br /> <br />x <br /> <br />or Produced Identification <br /> <br />"':;'~'~"'" W, GOMEZ <br />/!"i~~;:. MY COMMISSION * DO 680992 <br />~,J,~.~1 EXPIRES: June .3. 2011 I <br />..1"'.....'<1;., Baed"" l-,'lI NOlary PutlIlC Und-*'I$ . <br />11,"'t'flln:.ifl .' <br /> <br />Identi fication Produced <br /> <br />~e-z <br />