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<br />6. Based on infonnation and belief, the statement which I have marked below is true in a relation to the
<br />entity submitting this sworn statement. (Please indicate which one (I) of the following three (3)
<br />statements is applicable.)
<br />
<br />X (1) Neither the entity submitting this sworn statement, nor any of its officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of the entity, or
<br />any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36
<br />months.
<br />
<br />(2) The entity submitting this sworn statement, or one or more of its officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of the entity, or
<br />any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36
<br />months.
<br />
<br />(3)The entity submitting this sworn statement, or one or more of its officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of the entity, or
<br />any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36
<br />months. However, there has been a subsequent proceeding before a Hearing Officers of the State of
<br />Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer detennined that it
<br />was not in the public interest to place the entity submitting this sworn statement on the convicted vendor
<br />list. (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 P ARGRAPH 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 CONRACT 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 />
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<br />
<br />SIGNATURE OF AFFIANT
<br />
<br />Ramon Castella, P.E., LEED AP
<br />(Printed or Typed Legal Name of Affiant)
<br />
<br />- ,
<br />
<br />State of tJcrlC1C\ County of Ll'l)m'I' (hrlt'l
<br />Sworn to and subscribed before m~ day of
<br />
<br />UtiLi
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<br />
<br />,2010 by
<br />
<br />J< (llmr(\ ~QfuJ I () . OF ~ l fF D A P
<br />
<br />Jf5Si(~Cl- Pf(ll.
<br />Notary's Name Printed, Stamped or Typed
<br />
<br />/ or Produced Identification
<br />
<br />Notary Seal:
<br />
<br />Personally known:
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