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<br /> • market value under an arm's length agreement, shall be a prime fade 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 /> • 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 /> 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 /> `✓ 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 /> The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> O 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 /> 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 /> • 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 TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> ® By: pi /
<br /> ®
<br /> (Signature)
<br /> Hora ICS
<br /> • (P ' ted Na e)
<br /> rre5l(Jen-1-
<br /> (Title)
<br /> ® Sworn o and subscribed before me this /() day of bax_.R-y lbA V , 20 1 ' - , by
<br /> ® (AFFIX NOTARY STAMP HERE)
<br /> 0
<br /> • Samantha Jenkins cgnature: Notary Pub lis-St4te of Florida
<br /> NOTARY PUBLIC 0- --k ss- kdn
<br /> ®
<br /> c f 'STATE OF FLORIDA Print or Type Commissioned Name
<br /> Comm#GG145197
<br /> Persona nENopas_94442Produced Identification
<br /> Type of Identification Produced PC, OL 01(0 U a -6P 5- j -yah-0
<br /> ®
<br /> 10/1998 3 of 7
<br /> Au40ice e `Tc-c<rl-s oc - t i tin ` c RFP. R-1)-0
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