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<br />e <br /> <br />e <br /> <br />e <br /> <br />6. Based on infonnation 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 (I) of the following three <br />(3) statements is applicable.) <br /> <br />_X_ (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 affiliate 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 officers, directors, <br />executives, pminers, 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 affiliate 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 detennined 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 I (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 STJ\,.TUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE <br />INFOR ~ CaNT !NED IN THIS FORM. <br /> <br />'f f Enrique Crooks, P.E. <br />IGNA T (Printed or Typed Legal Name of Affiant) <br /> <br /> <br />State of rlall,J (^- County of (Y\J,WV1J,.. - O,2'-('LL- . <br />Sworn to and subscribed before me this 81-,;1::; day ofJ~/;C <br /> <br />&n'F L.wKs tii-!zi <br /> <br />A j..>(-A(.\/l ctr~("- '&(TU}()'~ /6 . v~ <br />Notary's Name Printed, Stamped or Typed <br /> <br />Personally Known: ~ or Produced Identification <br /> <br />, 2007 by <br /> <br />Identification Produced <br /> <br />