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<br />. <br />. <br />:t <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />(t <br />o <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br />. <br /> <br />- <br /> <br />" <br /> <br />market value under an ann's length agreement, shall be a prime facie case that one person <br />controls another person. A person who knowingly enters into a joint venture with a person who <br />has been convicted of a public entity crime in Florida during the preceding 36 months shall be <br />considered an affiliate. <br /> <br />11.5. I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural <br />person or entity organized under the laws of any state or of the United States with the legal power to <br />enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or <br />services let by a public entity, or which otherwise transacts or applies to transact business with a public <br />entity. The tenn "persons" includes those officers, directors, executives, partners, shareholders, <br />employees, members, and agents who are active in 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 the entity <br />/ 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, partners, <br />shareholders, employees, members, or agents who are active in the management of the entity, nor any <br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, <br />1989. <br /> <br />The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, <br />shareholders, employees, members, or agents who are active in the management of the entity, or an <br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, <br />1989. <br /> <br />The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, <br />shareholders, employees, members, or agents who are active in the management of the entity, or an <br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, <br />1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of <br />Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the <br />State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer <br />determined that it was not in the public interest to place the entity submitting this sworn statement on the <br />convicted vendor list. (Attach a copy of the final order.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE <br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, <br />THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I <br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO <br />A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA <br />STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. <br /> <br />~ <br /> <br />---tedl'-/--0 tauSZ--( ~ <br /> <br />(Printed N~h l..-LCX- l'l...( t:1 tJ l{e~ <br />(Title) -------~ S p----- <br /> <br />Sworn to and subscribed before me this \S~ day of__~\-\. __ <br />jj'l\1~ -1 r$ oCSi K. . <br /> <br />(AFFIX NOTARY STAMP HERE <br />JASON R. WESTFORT <br />MY COMMISSION # DO 992109 <br />PIRES: June 13.2014 . <br />ded Thru Notary Public Underwnters <br /> <br /> <br /> <br /> <br />Signature: Notary <br /> <br />f Florida <br /> <br />Print or Type Com <br /> <br />OR Produced Identification <br /> <br />Personally Known <br /> <br />Type of Identification Produced __________________ <br /> <br />10/1998 <br /> <br />30f7 <br /> <br />18 <br />