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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. 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 />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 />
<br />X 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 />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 THRESHOLD T PROVIDED IN SECTION 287,017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF ANY, CHAN INFORMATION CONTAINED IN THIS FORM,
<br />
<br />By:
<br />
<br />
<br />(Signature) ,
<br />Manuel Synalovskl
<br />
<br />(Printed Name)
<br />Managing Principal
<br />(Title)
<br />
<br />~i\ ,20 \~ ,by
<br />c--RoJ:0l C ."iYI~
<br />
<br />M Swo~n t~nd subscribe9 before me this \ '? day of
<br />~~alfJJJ,lJ\ ,)'{.V'4\O~~\
<br />~,~\.. c. MAR%:"~
<br />~~~~~1:A~STAMP HERE)
<br />! .."&~ ~ \9, 201~i... \.
<br />:: :~~ <p..~-::.
<br />:: .~ .7':-
<br />=*: ..... :oo::c=
<br />~ A ~ ~OO 9\\3384 i @~
<br />~-tJ.. ~ .~..C)~
<br />~ ~ ..101~ 8onde<l~~e~<:'.. Q:'~ /'
<br />%;~rl~~J~~~n V OR Produced Identification
<br />'1,,;UBL/C STI'- \\'~
<br />I""" fl" II \ \\\\
<br />Type ot Identification Produced
<br />
<br />Signature: Notary Public - State of Florida
<br />'T~ ~ \ C. Met (\ V\
<br />Print or Type Commissioned Name
<br />
<br />V'\ I c1\
<br />
<br />10/1998
<br />
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