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<br />.
<br />
<br />.
<br />
<br />.
<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 I (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 />CONTRAC~TEXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017,
<br />FLORIDA ST. TUTES F THE CATEGORY TWO OF ANY CHANGE IN THE
<br />INFr~ATI N CONIAI N THIS FORM.~ . D-
<br />
<br />/t [6-..("\0<; ~. ~Q~{,"::;" \: "~.
<br />
<br />SIGNA TURE OF AF (Printed or Typed Legal Name of Affiant)
<br />
<br />State of ~\D( iO~ County ottl\~6.M\ - D(,-~ --r
<br />Sworn to and subscribed before me this n\-\r- day of ~) '/
<br />
<br />, 2007 by
<br />
<br />
<br />1v-() Notary Seal:
<br />
<br />Personally Known:' v<.
<br />
<br />or Produced Identification
<br />
<br />,,,,,\\"y'~II,,, Amarilis Eguino
<br />ol'~~"'~1::'"
<br />f~"-ib":~~COMMISSION ID~661950
<br />\~~~~:t",$ EXPIRES: MAY 12,2011
<br />,+,,,~~\\,, WWW.AA!lG!.<NOTAllf.com
<br />
<br />Identification Produced
<br />
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