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(07-07-02) General Architectural Services
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Alleguez Architecture
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Last modified
2/25/2011 4:59:02 PM
Creation date
2/25/2011 4:58:29 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. General Arch. Svcs.
Bid No. (xx-xx-xx)
07-07-02
Project Type (Bid, RFP, RFQ)
RFQ
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<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 /> <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 IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, <br />FLORIDA STATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE <br />INFORMATION CONTAINED IN THIS FORM. <br /> <br />~~_-:2L/ Ana Alleguez <br />SIGNA TU~ <,jP'AFFIANT (Printed or Typed Legal Name of Affiant) <br /> <br />State of F/o,;d-::1 County of l0iV}r{)/ - W-L- <br />Sworn to and subscribed before me this 2.J day of c::J1;qtd <br /> <br />t1fY/ll ?1 J J tt,6u~-:? <br /> <br />Li d/ cL- 12e2-- <br />Notary's Name printe:7d or Typed <br /> <br />Personally Known: or Produced Identification _ <br /> <br />, 2007 by <br /> <br />Notary Seal: <br /> <br />i~ a\. Lidlce perez <br />~ ~ . My Commission 00240848 <br />"', "" ,,01 ' es December 07 2007 <br /> <br />Identification Produced <br /> <br /> <br />" <br /> <br />J <br />
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