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<br />market value under an arm'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 t~ transact business with a public
<br />entity, The term "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 THRESH AMOUNT PROVIDED IN SECTION 287,017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF ANY, AN E IN THE INFORMATION CONTAINED IN THIS FORM.
<br />
<br />By:
<br />
<br />
<br />e) /!t(ld r./l.LLJ (hV; yr; 6
<br />(Printed Name) /)
<br />. I/~(D~
<br />(Title) .
<br />
<br />.A. Sworn to and subscribed before me this ~ day of
<br />.ct1f1 d Y.1...u.J CrSt ./1 YJ r::.; ,
<br />
<br />(AFFIX NOTARy~<M~~
<br />NOTARY PUBLIC-STATE of NEW YORK
<br />No.01NE611734D
<br />Qualified In Nassau county
<br />My Commission expires I () /2.}-I/6-.
<br />,
<br />
<br />Personally Known X' OR Produced Identification
<br />#
<br />Type of Identification Produced
<br />
<br />f1 ~{{ , 20-.l.L, by
<br />
<br />an1yx~
<br />
<br />Sjgnatu~: Notary Public - State of New York
<br />l' tlHt-Ol. Y tt.J IV e,:? 0
<br />Print or Type Commissioned Name
<br />
<br />1011998
<br />
<br />30f7
<br />
<br />01P,O
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