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market value under an arm's length agreement, shall be a prime facie case that one person
<br />t:vntrbl9 mothvi- pt mom. A pwraon who knowingly enters into a joint venture with a person who
<br />nas Been convicted or a puBr;c entity er"ur in FI,,JZ1, daring tno p«eediny 36 months shall be
<br />consiaereti an andiate.
<br />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 />servivec let By a peoliv vritity, or 11210 otPierwise transacts or applies to transact business with a public
<br />entity. I Me term "persons" inciudes [dose orncers, direvtvr., c;zcuati.e, paPteera, n.r�Molaers,
<br />employees, members, anB agents wno are active in management or 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 />iveitner tRe entity suomining this s-orn 3t.turrrent, nor any at it'J omcers, directors, executives, partners,
<br />snarelloltiers, employees, memBers, or agents wno are acrve in Me m_i-.ayerR .t or IPPV olltity, nvr any
<br />affiliate of the entity has been charges with anti convicted or a puBlic entity crime subsequent to uuly -I,
<br />1989.
<br />The entity submitting this swam statement, or one or more of its officers, directors, executives, partners,
<br />.ZMZ;rvMaltio, , orrlployecz, rROM. )er., or agents who are active in the management of the entity, or an
<br />arrlliate or Me entity Bas Been cfiargeti witA anis conzioteB at a paBlie entity arirrlo Qunsegaent to July 1,
<br />I gay.
<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 />lady. Flv:.c►or, tMere Mui Boon a subsequent proceeding before a Hearing Officer of the State of
<br />Florida, Division or Administrative Bearings anti the F;,,uI Order ontur.a oy tna Rearing Officer of the
<br />Mate or Floritla, Division or m0ministrative Flearings anti the Final Order entered By Me Fleariny Orrrvvr
<br />determined that it was not in the public interest to place the entity submitting tnis sworn statement on the
<br />convicted vendor list. (Attach a copy of the final order.)
<br />I OIvDERS I AIgD I FIA I i HE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />P0617 -IC r -M I I I r IDEM i IFIED IR PARAGRAPFI 1 (OME) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
<br />I FIA I I M15 rMRM 15 vAl•ID i FIROUGR 13ECEMEEK a -I OF I rIE CALEMDAR TERR In vvFIICR I I IJ Fli_ED. I
<br />HLSO UNDERSTmND t Mm i I mlCl REMOIRED i V IRM51RIM I RE PUB[I%, EM I i I r PRIOR 10 EF -4 I ERIMG In 10
<br />A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SEC t IOM z-of.'u i t, FbORIDA
<br />STATUTES, FOR CATEGORY TWO OF ANY, CHANGE 77RMATION CONTAINED IN THIS FORM.
<br />Sy:
<br />�Si na ur
<br />(Rued Name)
<br />LE
<br />(Title)
<br />Sworn to anB suoscriBed Berore me irlis `'6 aay or
<br />An
<br />( ,..0+ua,,, AR1Y BEAR RUFF An
<br />:•"�°= notary PuAhc • Mate or Florida _
<br />' Comml:aien M FF ytsvzr4 Siyn turd Not Publi aorida
<br />ply Comm Fxplres Apr 19, : �rzu_-
<br />'' Bonded Throe jh 10110nar Il Rsn Print or I ype Commissioned Ilam e
<br />Personally Known OR Produced Identification
<br />Type of Identification Produced
<br />3of10
<br />Luke;,' La.,a3: wiling, Inc.
<br />v4f
<br />
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