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(07-08-01) Prof. Design Svcs. for Heritage Park and Parking Garage
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Tim Haahs Engineers
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Last modified
2/28/2011 3:50:47 PM
Creation date
2/28/2011 3:44:14 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. Design Svcs. for Heritage Park & Pkg Garage
Bid No. (xx-xx-xx)
07-08-01
Project Type (Bid, RFP, RFQ)
RFQ
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<br />I. <br />I~ <br />I <br />I <br />I <br />I <br />I <br /> <br />,I <br />I <br />I <br />II <br />II <br />I <br />I <br />I <br />I <br />I <br />I <br />II <br />I <br /> <br />II <br />II <br />II <br /> <br />- <br /> <br />6. Based on information and belief, the statement which I have marked below is true in a relation <br />to the entity submitting this sworn statement. (Please indicate which one (1) of the following <br />three (3) statements is applicable.) <br /> <br />X (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 <br />management of the entity, or any affiliate of the entity has been charged with and convicted of a <br />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, <br />executives, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, or any affiliate of the entity has been charged with and convicted of a <br />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, <br />executives, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, or agents who are active in management of the entity, or any affiliate of <br />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 <br />Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer determined <br />that it was not in the public interest to place the entity submitting this sworn statement on the <br />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 <br />FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THE PUBLIC <br />ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE <br />CALENDAR YEAR IN W' ICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT <br />ENTERED INTO, WHI EVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM <br />RE I D TO INFORM HE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN <br />E ES OF THE TH HOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA <br />S TV' FOR T C GORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED <br />I T ~~ F 'k I <br /> <br />II HERNANDO J. NAVAS <br />(Printed or Typed Legal Name of Affiant) <br /> <br /> <br />dayof rJC'~b~,r <br /> <br />, 2007 by <br /> <br />Identification Produced <br />
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