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<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 (I) of the following three <br />GE3tstfltements is applicable.) <br /> <br />~] ,) Neither the entity submitting this sworn statement, nor any of its officers, directors, <br />ex ll~S, 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 />CONTRACT I~ EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, <br />__-E ORIDA Sf! A TUTES FOR THE CA TEGORY TWO OF ANY CHANGE IN THE <br />,/ I INFO T U ~ T AINED IN THIS FORM. <br /> <br />~ S G tM-t {Y'\ A xVv-€ (( <br /> <br />(Printed or Typed Legal Name of Affiant) <br /> <br />State of Cou of {Y1,'nrn;A~(je. /J () <br />SW<p=t\ to and subscribed be e me this.::;J.-j day of /-jtlJ a.!1;:f/- , 2007 by <br /> <br />\J ~ . . ,~ a wcl <br /> <br />. <br /> <br />. <br /> <br /> <br /> <br />~ <br /> <br />Notary Seal: <br /> <br />Personally Known: <br /> <br />rJ <br />Identification Produced ./ <br /> <br />or Produced Identificatio~ <br />))Y-hJe;; b L(~ ~AIl S "(' <br /> <br />","It"" <br />..,\~y p/'6"" MARJORIE JOSEPH <br />.:'''m.{'''~ <br />:. · · . ~ Nolary Public. Slale of Florida <br />.... .- <br />;~ fl.....IMy Commission Expires Jan 22. <br />" 1'1' (f.;'\'" <br />",.,?:.:,~.\\' Commission # DO 283732 <br />