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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 />11.5. 1 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 />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 />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 />X 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 />X 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 Hearirfg 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 "age the entity submitting this sworn statement on the
<br />f
<br />convicted vendor list. (Attach a copy of the I order.
<br />I UNDERSTAND THAT THE SUBMISSIO IS
<br />PUBLIC ENTITY IDENTIFIED IN PARAGR 1.1 (0
<br />THAT THIS FORM IS VALID THROUGH E E
<br />ALSO UNDERSTAND THAT I AM REQU D F
<br />STATUTES, FOR CATEGORY OTWO OF H N�
<br />By:
<br />�—Gr g $atist
<br />(Pr ted,Name)
<br />ndividual
<br />Sworn to and subscribed befo
<br />(AFFIX NOTA
<br />=0 TO THE CONTRACTING OFFICER FOR THE
<br />E�ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br />110F THE CALENDAR YEAR IN WHICH IT IS FILED. I
<br />RM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />AOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br />IN THE INFORMATION CONTAINED IN THIS FORM.
<br />day of �1W' I 20 L , by
<br />OWANDA QUINTANA
<br />MY COMMISSION # DD801302 Si r otal
<br />EXPIRES: July 30, 2412
<br />1 -800.3- NOTARY FI, Notary Disco ASSOC. CO.
<br />Print or Type Co
<br />Personally Known OR Produced Identification
<br />Type of Identification Produced
<br />10/1998 3 of 7
<br />is — State of Florida
<br />ned Name
<br />
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