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<br />11.6.
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<br />market value under an arm's length agreemen~ 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 enUty crime In Florida during the preceding 36 months shall be
<br />considered en affiliate. .
<br />
<br />11.6.
<br />
<br />I understand that a "parson" as defined In Para. 267.133(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 Conlracts for the provision of goods or
<br />services let by a public entity, or which othelWlse transscts or applies to transact business with a public
<br />entity. The tenn "persons" Includes those officers, directors, executives, partners, shareholders,
<br />employees, members, and agents who are active In management of any enUty.
<br />
<br />Based on infonnatlon and belief, the stetement which I have marked below 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 eny of it's officers, directors, executives, partners,
<br />shareholders, employees, members, or agents who are active In the management of the entity, nor eny
<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 />efflliate 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, execu1lves, 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 subsequenlto 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 Hearin9s and the Flnel Order entered by the Hearing Officer
<br />detennlned 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 THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES, FOR CATEGORY 1'NO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
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<br />(Signature) \ tI .
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<br />J,.. (Title) ~-
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<br />Sworn to and subscribed before me this :Lt day of
<br />
<br />By:
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<br />, 20.!L, by
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<br />(AFFIX NOTARY STAMP HERE)
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<br />Personally Known
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<br />OR Produced Identification
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<br />IlAHIlAU ABIDIAN
<br />MYCOl.QllIISION'DDll8S6~
<br />EXPIAfS< May 9, 2014
<br />BDl1ded TNu Not&'YPilDlc~,.\ri'iler.
<br />
<br />f0f1998
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<br />Type of Identification Prod uced
<br />
<br />3017
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