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Metric Engineering #1
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(07-07-01) Prof. General Engineering
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Metric Engineering #1
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Last modified
2/18/2011 11:19:25 AM
Creation date
2/18/2011 11:17:44 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
P.E.
Bid No. (xx-xx-xx)
07-07-01
Project Type (Bid, RFP, RFQ)
RFQ
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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 />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 />I UNDERSTAND THA T THE SUBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (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 />THA T I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A <br />CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, <br />FLORIDA STATUTES FOR THE CA TEGORY TWO OF ANY CHANGE IN THE <br />INFORMA T N CONTAINED IN THIS FORM. <br /> <br /> <br />Robert Linares, PE <br />(Printed or Typed Legal Name of Affiant) <br /> <br />State of FLorl/)4 County of fj! Am / _1'y:;D6 <br />Sworn to and subscribed before me this d- J day of PUC7 U51 , 2007 by <br /> <br /> <br />Notary Seal: <br />or Typed <br /> <br />"l~1I111 M II G.. <br />",~~.y. P/.I',:'" ore a urban <br />If:' ~":~:~ Co~mi.IJioD # DD353547 <br />'::;.~.>~..'jJ E.tplres: SEP. 08, 2003 <br />"'~-:- ::' ' :~/ Bonded Thru <br />',,, ,,,II A I . Bo <br />. " t llDlI.: nding Co., Inc. <br /> <br />Personally Known: <br /> <br />or Produced Identification <br /> <br />Identification Produced <br />
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