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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.
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<br />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-Iaws- of- any- state -or-of-the - U nited- States-with - the -Iegal-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-te rm-" pe rso ns" - i ncl ud es-th ose-office rs;- d i recto rs;- executives;- pa rtn ers;- sha rehol d e rs;-
<br />employees, members, and agents who are active in management of any entity,
<br />
<br />.,/
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<br />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,)
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<br />11.6.
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<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,
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<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 A~EQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THRESH LD AMOUNT PROVIDED IN SECTION 287,017, FLORIDA
<br />STATUTES, FOR CATEGORY ANY, NGE IN THE INFORMATION CONTAINED IN THIS FORM,
<br />
<br />By: ' '.
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<br />(Signat \evp/l6E {;P/1 >~/.f ~
<br />(Printed Name) /J J A ; /"
<br />;VMS1~"" r
<br />(Title)
<br />
<br />JP d~olto ~p~.z~?;~e ~e this P-7 day of
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<br />(AFFIX NOTARY STAMP HERE)
<br />
<br />
<br />Personally Known
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<br />
<br />Type of Identification Produced
<br />
<br />10/1998
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<br />3 of?
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