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<br />'.
<br />
<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. r 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 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 rel~tion to the entity
<br />submitting this sworn statement. (Indicate which statement applies.)
<br />
<br />..si.- 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 t
<br />1989.
<br />
<br />The entity submitting this sworn statement. or one or more of its officers, ~irectors. executives, partners,
<br />shareholders, employees, members. or agents who are active in the management of the entity, or an
<br />affiliate cif 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 Offic~r 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 6f 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.ONL Y AND,
<br />THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF T~Cf-h{:NDAR YEAR. IN WHICH IT IS FILED. I
<br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM.]}-Ic/uBLlC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE THRESHOLD A OO.,....N'I' J~ROVIDED IN SECIlON 287.017, FLORIDA'
<br />STATUTES, FOR CATEGORY TWO OF ANY, CH.A..NG JNlH ~F: !RMA'ilOJ'fC5i\iTAINED IN THIS FORM.
<br />---- .
<br />/// By:
<br />
<br />
<br />~__(Slgnjl re) /C\
<br />l1...Alt"'rV '" OOV-eL.
<br />(Prlo@d Name) --\-
<br />~r es-:r ~r='{"') J
<br />(Tltle) r<- (/l
<br />
<br />PJ-s;ygrn."to and bscribed before ~ this d ( ..day of yY/ frY
<br />I' f'(..e;,....; 0 ~ - t"1Z f s,' d €...J '-. /
<br />
<br />(AFFIX Nq.,01-fi.y ~Aii~ORIDA
<br />......,,'.., Maritza Gomez
<br />tw....i Commission # DDB84556
<br />~~i Expires: APR. 27,2013
<br />BONDED TIIRU ATLhN'IlC BOIlDI t1G co.. ~c.
<br />
<br />, 20-.LL, by
<br />
<br />Personally Known X OR Produced Identification
<br />-- '
<br />
<br />Type of Identification Produced
<br />
<br />
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