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market value urider an arm's length agreement, shall be a prime facie case that one person
<br />controls another person, A person who kncrxingly enters into a joint venture with a person who
<br />has been convicted of a public entity ulme in Florida daring the preceding 36 months shall be
<br />considered an affiliate.
<br />11.5. 1 understand that a "person" as defined in Para, 287.133(9)(e), Ftodda Statutes, means any natural
<br />person or entity organized under the laws of any state or of the United Slates with the legal power to
<br />enter into a binding Contrart and which Bids or applies to Bid on Contracts for the provision of goods or
<br />services lel by a pubfic 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 enter.
<br />11.6. Based on information and belief, the staternani which I have marked below is true in relation to the enUy
<br />submitting this sworn stalement. (Indicate which statement applies.)
<br />l� Neither the entity submitting (his sworn statement. nor any of it's officers. directors, execLr ives, lu;wners,
<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 convitted of a public entity crime subsequent to July 1,
<br />1989.
<br />The entity submitting this sworn statement, o: one or more of its officers, directors, executives, partners,
<br />shareholders, employees, members, or agents who are active in the management of the sntity, or an
<br />affiliate of the entity has been charged with and convicted of a public entity gime subsequent to July 1,
<br />1989.
<br />The entity submitting this SWOM statement, of one or more of its officers, directors, executives, partners,
<br />shareholders, employees, members, or agents who are aa(ve in the management of the entity, or an
<br />affiliate of the entity has been chargett with and convicted of a public entity crime suf7S uient to July 1,
<br />1989. However, there has been a subsequent proceeding before a Hearing Officer of the Slate of
<br />Florida, Division of Administrative Hearings and the Final' Order entered by the Hearing offioer of the
<br />State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
<br />determined W1 it was nut 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 FORK! TO THE CONTRACTING OFFIUER FOR THE
<br />PUBLIC ENTITY IDENTIFIEO IM PARAGRAPH 11.3 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY Ohtt_Y 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 TFIRESHOLD AM0L9qgBQVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF I W, GRANM IN TH FO 1 *TION CONTAINED IN THIS FORA,
<br />By:
<br />Jason R. Wells
<br />( r Name) President
<br />(Title) - -- --
<br />Sworn to and subscribed before me this 23rd day of August 24 16 , by
<br />Jason R. WelJs
<br />(AF FIX �Y 8WIWMERQJMAN
<br />ray comm--s$ION 0 FFZUAG7
<br />'• EXPIRES Jung 2.5. 7x719
<br />Signature: N toPirb}ic 4 State of Florida
<br />1x7 cI ct #7. (MR
<br />Print or Type Com miSSloned Name
<br />Personally Known V OR Produoed Identification
<br />Type of Identification Produced
<br />i J'L-,�i
<br />
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