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F� 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 />l entity. The term "persons" includes those officers, directors, executives, partners, shareholders,
<br />I 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 manaament 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 .0�-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 Fi}}rarOrder entered by the Hearing Officer
<br />determined that it was not in the public interest to place the a fty submitting this sworn statement on the
<br />convicted vendor list. (Attach a copy of the final order.)
<br />I UNDERSTAND THAT THE SUBMISSION OF HIS F TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAP 11.1 (ON ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br />THAT THIS FORM IS VALID THROUGH D C ER 3 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
<br />ALSO UNDERSTAND THAT I AM REQUI O INF RM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE T MOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF A Y, E IN THE INFORMATION CONTAINED IN THIS FORM.
<br />By:
<br />(Si n ur
<br />eg ,tista
<br />(Printe Na e)
<br />In ividual
<br />(Title)
<br />Sworn to and subscribed before mehis day of �,\ , 20121 , by
<br />(AFFIX NOTARY STAMP HERE)
<br />WANDA QUINT A Sign re No a ublic — State of Florida
<br />MY COMMISSION # 801302
<br />EXPIRES: July , 2012 Print or Type C missioned Name
<br />1- 800-3- NOTARY FI. Notary D" wunt Assoc. Co.
<br />Personally Known OR Produced Identification
<br />Type of Identification Produced
<br />10/1998 3 of 7
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