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(07-07-02) General Architectural Services
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Last modified
2/23/2011 11:59:27 AM
Creation date
2/23/2011 11:59:13 AM
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. General Architectural Svcs.
Bid No. (xx-xx-xx)
07-07-02
Project Type (Bid, RFP, RFQ)
RFQ
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<br />o <br /> <br />o <br /> <br />o <br /> <br />6. Based on infonnation and belief, the statement which I have marked below is true in a relation to the entity submitting this sworn <br />statement. (Please indicate which one (1) of the following three (3) statements is applicable.) <br /> <br />----X.. (1) Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, <br />employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged with <br />and convicted ofa public entity crime within the past 36 months. <br /> <br />_(2) The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, <br />employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged <br />with and convicted ofa public entity crime within the past 36 months. <br /> <br />_(3) The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, <br />employees, members, or agents who are active in the management of the entity, or agents who are active in management of the <br />entity, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. <br />However, there has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of Administrative <br />Hearings and the Final Order by the Hearing Officer detennined that it was not in the public interest to place the entity submitting <br />this sworn statement on the convicted vendor list. (Attached is a copy of the final order.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC <br />ENTITY IDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM <br />IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF <br />THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM <br />REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE <br />THRESHOLD AMOUNT PROVIDED IN SECTION 287.0]7, FLORIDA STATUTES FOR THE CATEGORY TWO OF ANY <br />CHANGE IN THE INFOR A TION CONTAINED IN THIS FORM. <br /> <br /> <br />ando M, Rizo AlA Chief 0 erations Officer <br />mted or Typed Legal Name of Affiant) <br /> <br />State of Florida County of Dade <br />Sworn to and subscrihed before me this <br /> <br />day of August. 2007 by: <br /> <br />A en fi1..U)o <br /> <br />tf. ftz.o AlA <br />I <br /> <br />Notary Seal: <br /> <br />"............................ <br />SHJ~ f. .' ................, <br />I""~ .......LPH . <br />: ~~~' .~~. ./ 000502867 S <br />i .; ';J s 3/271201C S <br />: ~~~:.< BOnded Ihru (8001432-4254: <br />... "111\'" FIOflda NoI: . <br />..........................~. ANn. Inc : <br />............. <br /> <br />Personally Known: <br /> <br />x <br /> <br />or Produced Identification ~ <br /> <br />Identification Produced Valid Drivers License <br />
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