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(07-08-01) Prof. Design Svcs. for Heritage Park and Parking Garage
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IBI Group
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Last modified
11/29/2010 4:01:34 PM
Creation date
11/29/2010 4:01:14 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. Design Svcs for Heritage Pk
Bid No. (xx-xx-xx)
07-08-01
Project Type (Bid, RFP, RFQ)
RFQ
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<br />6. Based on information and belief, the statement which I have marked below is true in a relation <br />to the entity submitting this sworn statement. (Please indicate which one (1) of the following <br />three (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 <br />management of the entity, or any affiliate of the entity has been charged with and convicted of a <br />public entity 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, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, or any affiliate of the entity has been charged with and convicted of a <br />public entity 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 <br />management of the entity, or agents who are active in management of the entity, or any affiliate of <br />the entity has been charged with and convicted of a public entity crime within the past 36 months. <br />However, there has been a subsequent proceeding before a Hearing Officers of the State of <br />Florida, Division of Administratlve Hearings and the Final Order by the Hearing Officer determined <br />that it was not in the public interest to place the entity submitting this sworn statement on the <br />convicted vendor list. (Attached is a copy of the final order.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER <br />FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THE PUBLIC <br />ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE <br />CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT <br />ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM <br />REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN <br />EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA <br />STATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED <br />IN THIS FORM. <br /> <br /> <br />~n.. Scharf <br />(Printed or Typed Legal f\Jame of Affiant) <br /> <br />State of Florida Co .Jnty 0 _. ro ard <br />Sworn to and subscribed before rne is q day of October <br /> <br /> <br />~~~ <br />Notary's Name Printed, Stamped or Typed <br />Personally Known: v--- or Produced Identification <br /> <br />, 2007 by <br /> <br />Notary Seal: <br /> <br />~tJlY ~II~ <br />+0 ....... ~ KATHLEEN ANN GEIIDEMANN <br />......bI.. * MY COMMISSION' DD 549213 <br />~~... EXPIRES: May 20,2010 <br />"'tOFf\.~<> Bonded Thru Budget NotllY Services <br /> <br />Identification Produced <br />
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