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I <br />6. Based on information and belief, the statement which I have <br />which statement applies] marked below is true in relation to the entity <br />submitting this sworn statement. [Inds <br />X1 directors executives, <br />Neither the entity submitting this sworn statement, nor any of its officers, <br />partners, shareholders, employees, members, �dtconvicted of a public entity grimensubsequent o,July, <br />any affiliate of the entity has been charged <br />1, 1989. <br />The entity submitting this sworn statement, or one or more of its officers, directors, executives, <br />partners, shareholders, employees, members, ith andtconviicted of a public entity grimensubsequent oJuly, <br />any affiliate of the entity has been charged <br />1, 1989. <br />The entity submitting this sworn statement, or one or more of its officers, directors executives, <br />partners, shareholders, employees, members, ith andtconv who are of a public entity grimensubsequent to July <br />any affiliate of the entity has been charged <br />1, Florida, However, there has been andtth Final Order entered bylthe Hearing Officer of the <br />rida, Division i Administrative Hearings <br />State of Florida, Division of Administrative <br />interest the entity submitting this sworn the <br />statementOonithe <br />determined that it was not in the public P <br />convicted vendor list. [attach a copy of the final order] CTING <br />I UNDERSTAND THAT THE SUBMISSION OF THIS (ONE) EM TO THE CONTRA IS FOR THAT PUBLOIC ENTITY ONLY <br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH YEAR IN WHI <br />AND, THAT THIS FORM IS VALID THROUGH M REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR N <br />IS FILED. I ALSO UNDERSTAND THAT I AM Q <br />ENTERING INTO A CONTRACT IN EXCESS O T TWO OF A D C 'N AMOUNT IN OTC E INF <br />ORMATION <br />287.017, FLORIDA STATUTES FOR CA I <br />CONTAINED IN THIS FORM. <br />[si <br />� da of � r ! , 203. <br />Sworn to and subscribed before me this d _ Y <br />Personally known i / <br />Notary ublic - State of Y �n r..1( A <br />OR Produced identification OFFICIAL SEAL <br />VAUGHN GRUBER <br />(Type of identification) COMMISSION # DD0661362Q <br />(Pri 4P"' Oct. 2 tihc)05 <br />commissioned name o otary pu <br />03- 4138.A -R <br />Form PUR 7068 (Rev. 06/11/92) <br />00402 -2 <br />