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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 infonnation and belief, the statement which I have marked below is true in relation to <br />V 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 convictecl 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 Rnal 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 detennined 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 ENTIiY 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 ENTIiY 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 /> <br /> <br />~WY <br />Jurle <br /> <br />20 () t . by <br />I~ <br />I <br /> <br />.~/ <br /> <br /> <br />END OF SECTION <br /> <br />PAGE 59 OF 78 <br />