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<br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br /> <br />6. Based on information and bel ief. 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 />(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 s\\orn 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 \\ ho are active in the management <br />of the entity. or agents who are active in management oflhe 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 C0Py of the final order.) <br /> <br />I L'NDERSTAND THAT THE SCBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS FOR <br />THE PLBLIC ENTITY ONLY AND. THAT THIS FORM IS VALID THROL'GH DECEMBER 31 <br />OF THE CALENDAR YEAR IN \VHICH IT IS FILED AND FOR THE PERIOD OF THE <br />CONTRACT ENTERED INTO. WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND <br />THAT I AM REQl;IRED TO INFORM THE PCBLIC ENTITY PRIOR TO ENTERING INTO A <br />CONTRACT IN EXCESS OF THE THRESHOLD AMOCNT PROVIDED IN SECTION 287.017. <br />FLORIDA STATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE <br />INJ TION CO;;V~T I!-iED l!-i THIS FORM. <br /> <br />---- ~k ()~? Leonardo Rodriguez, PE <br /> <br />SIGNA TCRE OF AF rANT (Printed or T~ ped Legal Name of Affiant) <br /> <br />State of Florida County of Miami - Dade <br />S\\orn to and subscribed before me this 21 day of August <br /> <br />. Z007 b\' <br /> <br />l1,tY VU'GLC EfiL~ lel Ii (/\ <br />I . . c I' I <br />_~!,-OX \({ (\. lc l \ r tC\ J <br /> <br />Notary's Name Printed. Stamped 0r T~ ped <br /> <br />Notary Sea I: <br /> <br />:.-;.~i!:\~~~._ MARIA Q COLINA <br />;';A,,:-: MY COMMISSION 11 00628868 <br />.~. 'P <br />"'~~'o."~~" EXPIRES March 21 2010 <br />(401 ~ fj98"~' 53 FloudaNolarvServ.cc com <br /> <br />Personall~ Known: <br /> <br />I <br />i' <br /> <br />or Produced Identification <br /> <br />Identification Produced <br />