O'Leary Design # 1 - Laserfiche WebLink

Home Browse Search

I I I I I I I I I I I I I I I I I I I convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this swom statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, or an affiliate of the entity has been charged with and convicted ofa public entity crime subsequent to July 1, 1989. The entity submitting this swom statement, or one or more of its officers, directors, executives, partners, shareholders, employees members, or agents who are in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this swom statement on the convicted vendor list. (attach a copy of the final order) 1 UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONL Y AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. COUNTY OF DADE w- Date: May 29, 2001 STATE OF FLO PERSONALL Y APPEARED BEFORE ME, the undersigned authority, William A. O'Leary. F.A.S.L.A. who, after first being swom by me, affixed his signature in the space provided on this 29th day of May, 2001 . G), RAQUELCARRAZANA ~ MY COMMISSION # CC934169 " EX?IRES Aug 11, 2004 1-800-3.NOTARY FL Nolanl ~ & Bonding,lnc .:, My commission expires: