Reso 2011-1729 - Laserfiche WebLink

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/ 11.6. enmy. I ne term '.persons" mclU~ mose officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. Baioed on information and belief, the statement which I have marked below is true in relation to the entity submitting this swom statement (Indicate which statement applies.) Neither the entity submitting this sworn statement, nor any of it's OffICers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. +t1~ entity submitting this swam statement. or one or more of its officers, directors, executives, partners, Shareholders, employees, members, or agents who are active in the management of the entity, or an affiiii;ite of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1988. ~. The entity submitting this sworn statement, or one or more of its officers, directors. executives, partners, shareholders, employees, members. or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the State 'of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I AlSO UNDERSTAND THAT I AM REQUIRED TO INFORM T PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESH PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORYlWO OF ANY E INFORMATlpN CONTAINED IN THIS FORM. By: (Signatur~ IJbY (Printed Name) O(,utJet2. (Title) om to and SUbsCri~1.tfore me this ~ ~ ~day of Sr-r ,771 ~ \ . 20~, by (AFF.IX.N9~MlR15~~P""'~ ~ ~~"'" Comm# D00737586 5 . . ~ - Expires 12/1412011 :: s~ r#~ : '>vlJ;f:"1.rf}<I! Florida NotaryAssn.,lnc :: Print or Type Commissioned Name perso~:I~y~::.......m7"~~';roduced Identification ()L~ u Signature: Notary Public - State of Florida Type of Identification Produced 11111998 30f7 '" ) .~} J