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RFP No. 01-03-01 Comp. Insurance
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Last modified
6/13/2012 5:15:29 AM
Creation date
12/27/2010 3:27:19 PM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
Comp. Insurance
Bid No. (xx-xx-xx)
01-03-01
Project Type (Bid, RFP, RFQ)
RFP
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8. Based on information and belief, the statement which I have marked below is true in relation <br />to the entity submitting this sworn statement. (Please indicate which statement applies) <br />Neither the entity submitting this sworn statement, nor any officers , directors, <br />executives partners, shareholders, employees, members or agents who are active in <br />management of the entity, nor any affiliate of the entity have been charged with and <br />convicted of a public entity crime subsequent to July 1, 1989. <br />The entity submitting this sworn statement, or none of the officers, directors, executives, <br />partners, shareholders, employees, members or agents who are active in management of the entity, <br />or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent <br />to July 1, 1989. (Please indicate which additional statement applies) <br />There has been a proceeding concerning the conviction before a hearing officer of the <br />State of Florida, Division of Administrative Hearings. The final order entered by the haring officer <br />did not place the person or affiliate on the convicted vendor list. (Please attach a copy of the final <br />order) <br />The person or affiliate was placed on the convicted vendor list. There has been a <br />subsequent proceeding before a hearing officer determined that it %vas in the public interest to <br />remove the person or affiliate from the convicted vendor list. (Please attach a copy of the final order) <br />The person or affiliate has not been placed on the convicted vendor list. Please describe <br />action taken by, or pending with the Department of General Services) <br />SIGNATURE <br />DATE <br />State of: <br />County of: <br />Personally appeared before me, the undersigned authority, <br />Who after first being sworn by me, affixed his /her signature in the space provided above on this <br />day of , 2000. <br />My commission expires: 2000 <br />Notary Public <br />
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