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<br />executives, partners, shareholders, employees, members, and agents who are active in
<br />management of any entity.
<br />
<br />11.6. Based on information and belief, the statement which I have marked below Is true In relation to
<br />the entity submitting this sworn statement. (Indicate which statement applies.)
<br />
<br />Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of
<br />the entity, nor any affiliate of the entity has been charged with and convicted of a public entity
<br />crime subsequent to July 1, 1989.
<br />
<br />The entity submitting this sworn statement, or one or more of its officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of
<br />the entity, or an affiliate of the entity has been charged with and convicted of a public entity
<br />crime subsequent to July 1, 1989.
<br />
<br />The entity submitting this sworn statement, or one or more of its officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of
<br />the entity, or an affiliate of the entity has been charged with and convicted of a public entity
<br />crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a
<br />Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order
<br />entered by the Hearing Officer of the State of Florida, Division of Administrative Hearings and the
<br />Final Order entered by the Hearing Officer determined that it was not in the public interest to
<br />place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of
<br />the final order.)
<br />
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBUC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBUC ENTITY ONLY
<br />AND, THAT THIS FORM IS VAUD THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS
<br />FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBUC ENTITY PRIOR TO
<br />ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION
<br />287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION
<br />CONTAINED IN THIS FORM.
<br />
<br />By: ~~
<br />
<br />(Signature) /
<br />Luisa Alonso
<br />(Printed Name)
<br />President
<br />
<br />(Title)
<br />
<br />"\\\111"', . ....., 7 " .
<br />Sworn 0 €l~suos ~~fore me thiS L '/ day of ~,,'-.::>~
<br />" ~. . '~
<br />~C5 .. ~.. ~
<br />~ ~ .. seplelJ} lS'~'. ~ ~
<br />(A FAX NOTA~$iA~ ~ER~~\ b~
<br />=-o:~ 'b. 9~:~::
<br />::: c .~ q? d: \ f\.)"b . C/) =
<br />~~"~~Q: ~ ~$: ~
<br />~11..~C:~ ~ l!?: ~
<br />~U';..'?",,: .... ~ Print or Type Commissioned Name
<br />~-1h ...:I;e:~..... l' ~
<br />"'llloFFLOR\\J'r.JJ..~~ ~ /) <-.
<br />Personally Known ~11''''''flll\\\\'lJK Produced Identification v--- C. r- .' . '" _ ~
<br />Type of Identification Produced ~c... ~ p '-' &. '-S..'IL' 'S'? 0 ~. Q , I \ ~ 0
<br />END OF SECTION
<br />
<br />.20:9 '{. by
<br />
<br />cp --=-
<br />Signature:~NOtary Public - Stat~,of Florida
<br />./ ~ ~ ~\~'TA~
<br />
<br />PAGE 59 OF 78
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