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<br />6. Based on information and belieL 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 aftiliate 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 ofticers. directors. <br />executives. partners, shareholders, employees, members, or agents who are active in the management <br />of the entity. or any aftiliate of the entity has been charged with and convicted of a public entity <br />crime vvithin 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 I-Iearing Officers of the State of Florida. Division of <br />Administrative Hearings and the Final Order by the I-Iearing Ofticer 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 TI-IE SUBMISSION OF TI-IIS FORM TO TI-IE 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 VALl)) THROUGH DECEMBER 31 <br />OF TI-IE CALENDAR YEAR IN WHICI-IIT IS fILED AND FORTI-IE PERIOD OF TI-[E <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 TI-IE CATEGORY TWO Of ANY CI.IANGE IN THE <br />INF R TION CONTAINED INTI-lIS FORM. <br /> <br /> <br />F. Antonio Rosabal. A.1. A., Principal <br />(Printed or Typed Legal Name of Aftiant) <br /> <br />State of florida County of Dade <br />Sworn to and subscri~)d before me this 25 <br />+o~~;...~~t- IRALDY ~ <br />~ MY COIMolISSlON t DO 968426 <br />* . <br />EXPIRES: March 7, 2014 <br />.~?~Of f\.O~~ Bonded Thnl Budge! Ndary ~ <br /> <br />day of Mav. 20 10 by <br /> <br />Notary's Name Printed. Stamped or Typed <br /> <br />Notary Seal: <br /> <br />Personallv Known: <br /> <br />j,/ <br /> <br />or Producedldcnti lication <br /> <br />Identi lication Produced <br />