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(07-08-01) Prof. Design Svcs. for Heritage Park and Parking Garage
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Land Design South
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Last modified
11/29/2010 4:33:44 PM
Creation date
11/29/2010 4:33:28 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 />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <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 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, 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 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 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 />INFO M TION CONTAINED IN TI-IIS FORM. <br /> <br />JL <br /> <br /> <br />Brad Currie <br />(Printed or Typed Legal Name of Affiant) <br /> <br />SIG AllURE OF AFFIANT <br /> <br />State of Fl:rid{ County of St. Lucie <br />Sworn to and subscribed before me this 3rd day of October, 2007 by Brad Currie. <br />... <br /> <br />...ilt.If;...n...... MARY E. CAlDWEll <br />Mary Caldwell Nc ~'1 . "JMY COMMISSION # DD619495 <br />,. ~:. .~j EXPIRES: December 4, 2010 <br />Notary s Name PrInted, Stamped or Typed "1.i:p....-.t~,. BondedThruNotaryPublicUnderwnters <br />, ,r..,,' <br /> <br />Personally Known: <br /> <br />or Produced Identification <br /> <br />X <br /> <br />Identification Produced <br />
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