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<br />'1
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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 />)
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<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 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 />L)
<br />I 11.6.
<br />I X
<br />I
<br />j )
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<br />Based on information and belieCtne statement wtlich-rliave marKed'b~elow~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 />I )
<br />
<br />)
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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 AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE THR SHOLD AMOUNT PROVIDED IN SECTION 287,017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF A ,CHANGE I T E INFORMATION CONTAINED IN THIS FORM,
<br />
<br />By:
<br />
<br />
<br />Sworn to and subscribed before me this 1 st
<br />Richard B, Bochnovich, P,E,
<br />
<br />day of
<br />
<br />
<br />,20.11-, by
<br />
<br />(AFFIX NOTARY STAMP HERE)
<br />- -
<br />
<br />-. .- -. .-
<br />
<br />",...." . G
<br />. ...t,,,,,v""8;-',, OMAYRA V, SER
<br />l"iJtEt>:~ Notary Public. State 01 Florida
<br />::. .. = My Comm Expires Jun 27, 2014
<br />';\1}: {JV:~ " .
<br />"'~~OFf~CJt:'~ CommiSSion # EE 4280 ~
<br />IIIl ""ltl"\\
<br />Personally K V' "' ication
<br />-
<br />
<br />Signature: Not
<br />Omayra V, Berq
<br />Print or Type Commissioned Name
<br />
<br />Type of Identification Produced
<br />
<br />10/1998
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