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<br /> ® market value under an arm's length agreement, shall be a prime facie case that one person
<br /> 0 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. 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 /> ® 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 /> ® 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 /> 0 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.
<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. e
<br /> ® Wii
<br /> re.
<br /> ® (Signatur-
<br /> Doug Riordan
<br /> ® (Printed Name)
<br /> atSole Owner / President
<br /> (Title)
<br /> ';Thorn to and-�ub/scribed before me this h/ day of f��r� , . , 20/- , by
<br /> ® �o uC-�Fi r 04r DAB /J /
<br /> 1
<br /> (AFFIX NOTARY STAMP HERE)
<br /> Q.i.W..AlVl -1IVVVVVVVVtll+
<br /> i
<br /> /,>. ELAINE MOSCHE: Signat e: Notary Public—State of Florida
<br /> (4 MYCONNISSION 4EE17rnH
<br /> ` EJsT:':ES:Mv:h01.ZG16
<br /> 4,X.:4.7f n Now,a At=Cc. Print or Type Commissioned Name
<br /> ® Personally Known xx OR Produced Identification
<br /> Type of Identification Produced
<br /> ® I0/1998 3 of 10
<br /> 0
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