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<br />the provision of goods or services let by a public entity, or which otherwise transacts or applies <br />to transact business with a public entity. The term "person" includes those officers, directors, <br />executives, partners. shareholders. employees, members, and agents who arc active in <br />management of any entity. <br /> <br />6. Based on information and belief, the statement which I have marked below is truc in a <br />relation to the entity submitting this swom statement. (Please indicate which one (1) of the <br />following three (3) statements is applicable.) <br /> <br />~ (1) Neither thc 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 S\\10111 statcment, or one or more of its officers. dir~ctors, <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 arc active in management of the entity, or any affiliate <br />of thc entity has bcen charged with and convicted of a public cntity crime within the past 36 <br />months. Ho\vever, there has been a subsequent proceeding before a Hearing Officer of the State <br />of Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer <br />determined that it was not in the public interest to place the cntity submitting this sworn <br />statement on the convicted vendor list. (Attached is a copy of the final order.) <br /> <br />I UNDERSTAND THAT THE StTBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS <br />FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALlD THROUGH <br />DECEr..'rBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE <br />PERIOD OF THE CONTRACT ENTERED INTO , WHICHEVER PERIOD IS LONGER. 1 <br />ALSO lJNDERST AND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY <br />PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT <br />PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR THE CATEGORY TWO OF <br />ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. <br /> <br />~~_ ~~r ---- Lanra;ne Lichtman, P'-esident <br />SIGNA TURE 0 AFFIANT /. (Printed or Typed Legal Name of Affiant) <br /> <br />." <br /> <br />31 <br />