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market value under an arm's length agreement, shall be a prime facia case that one person
<br />controls another person. A p-rson who knowingly enters into a joint venture with a person who
<br />has been convicted Lf a public entity crime in Florida during the preceding 36 months shall be
<br />considered an affiliate.
<br />5. 1 understand that a "person" as defined in Para. 287.133(i)(e), Florida Statutes, means any natural
<br />pers%n or entity organized under the laws of any state or of the United States with the legal power to
<br />e, -,ter into a binding C-MIItract 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. Thu term "persons" includes those officers, directors, executives, -partners, shareholders,
<br />employees, members, and agents who are active in management of any entity.
<br />6. Based on information and belief, the statement which I have marked below is true in relation to the entity
<br />i submitting this sworn statement. (Indicate which statement applies,)
<br />3'c Neither the entity submitting this sworn statement, nor any of its 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 />The entity submitting this sworn statement, or one or more of its officers, dircors, executives, partners,
<br />ati shareholders, employees, membara, 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 />The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br />shareholders, employees, members, or agznts 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. Howev=r, 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 Lhe
<br />convicted vendor list. (Attach a copy of the final order.)
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 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 287.617, FLORIDA
<br />STATUTES. FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM
<br />( ignatu e)
<br />(Printed Nagne)
<br />-2rdC f
<br />(Title)
<br />771171
<br />Sworn to and subscribed before me this / / day of �z::�11 f cU , by
<br />(AFFIX NOTARY STAMP HERE)
<br />RqMNMCGfflRY Signature Notary Public - State of Florima
<br />EXP$e; r 14Rt,�metns5!ON#FFQ22240 !f � �� '
<br />i��s. sNr 29. 2017 Print or Type Co missioned Name
<br />`R,+ Bonded U.aF,rn..q Athk Ur*mftpv
<br />Personally Known OR Produced Idendfication
<br />Type of Identification Produced
<br />Lukes' Landscaj,;ug, Inc. s or -iu
<br />4
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