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<br />c <br /> <br />. <br /> <br />o <br /> <br />6. Based on infonnation 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 />2- (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 detennined 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 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 WInCH IT IS FILED AND FOR THE PERIOD OF THE <br />CONTRACT ENTERED INTO, WInCHEVER PERIOD IS LONGER. I ALSO UNDERSTAND <br />THAT 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 />LORID TATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE <br />o ON CONTAINED IN THIS FORM. <br /> <br /> <br />OF AFFIANT <br /> <br />Stephen C. Smith, P.E. <br />(printed or Typed Legal Name of Affiant) <br /> <br />State of FL County of Broward It <br />Sworn to and subscribed before me this q / ~t' day of . I(~t/ SI <br /> <br />StEfl/EN (3, S/11i m-~ <br />J..i II)) 0111 oAJ i E/JSKi <br /> <br />Notary's Name Pri ted, Stamped or Typed <br /> <br /> <br />Personally Kno~: A-- or Produced IdentifIcation _ <br /> <br /> <br />Identification Produced <br /> <br />, 2007 by <br /> <br />Notary .J~a~, <br />!J'. <br />~~.. <br />~o,f\.df <br /> <br />Notary Public State of Florida <br />Linda Komoniewski <br />My Commission 00409952 <br />Expires 0312212009 <br />