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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 />11.5. 1 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 />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 />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 />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 />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 />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 />(Sig at e)
<br />`RAFAe W A
<br />(Printed Name) pp
<br />(Title)
<br />�) Sworn to and subscribed before me this � day. of A k , 20�, by
<br />' ef%VA - S I � !"� 'ms aaeaeesedNoeae ooeeeatse/1leuuoeeeeeeeao�eq
<br />en.r..`r.Ae vey�e�e��n
<br />(AFFIX NOTARY. STAMP HERE) h�� " "' n'^�a ZTnrn "D071770V
<br />Signature: Not licFao�prm
<br />leeeeietltl 9eeeeeeeeebeeteeCeeeee eepeeeeenee
<br />�.- ---- -= Print or Type Commissioned Name
<br />Personally Known_ OR Produced Identification
<br />We_ of Identification Produced
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