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<br />II <br /> <br />LJ <br /> <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 /> <br />'i <br /> <br />Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the entity, nor <br />any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July <br />I, ]989. <br /> <br />II <br /> <br />LJ <br /> <br />II <br /> <br />LJ <br /> <br />n <br /> <br />The entity submitting this sworn statement, or one or more of its officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the entity, nor <br />any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July <br />1, 1989. <br /> <br />LJ <br /> <br />n <br /> <br />The entity submitting this sworn statement, or one or more of its officers, directors, executives, <br />partners, shareholders, employees, members, or agents who are active in the management of the entity, nor <br />any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July <br />1, 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 oLFlorida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer <br />detennined 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 /> <br />LJ <br /> <br />n <br />u <br /> <br />II <br /> <br />LJ <br /> <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 <br />AND, THAT THIS FORM IS V ALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT <br />IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRlOR TO <br />ENTERlNG INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION <br />287.017, FLORlDA STATUTES FOR CATEGORY TWO OF ANY CHANG.E INlH INFORMATION <br />CONTAINED IN THIS FORM. <br /> <br />~t1T <br /> <br />[ signature] S.W. ERNST. PRESIDENT <br /> <br />II <br /> <br />LJ <br /> <br />n <br /> <br />LJ <br /> <br />n <br /> <br />LJ <br /> <br />II <br /> <br />:::::~l~~:::cr;bed befurj th;s <br /> <br />Lr <br /> <br />day of -rU ll~ r ,2000 <br /> <br />Y/.() ()J&{/~ <br /> <br />Notary Public - State of ~/(lCi <br /> <br />My commission expires {.t1!IL/ I oro <br />L. (!. frlOAJSO <br />(Printed typed or stamped <br />commissioned name of notary public) <br /> <br />LJ <br /> <br />II <br /> <br />LJ <br /> <br />OR Produced identification <br /> <br />n <br /> <br />LJ <br /> <br />(Type of identification) <br /> <br />n <br /> <br />LJ <br /> <br />"!i~':r.~'r~~',. <br />~~1" - ..t~ <br />~~~" ~ .~?;;~y <br />~"',~f..~r."" <br /> <br />L. C. ALONSO <br />MY COMMISSION # DO 328966 <br />EXPIRES: June 14, 2006 <br />Booded Thru Nolary Public UndefW,ilers <br /> <br />II <br /> <br />LJ <br /> <br />II <br /> <br />LJ <br /> <br />II <br /> <br />LJ <br /> <br />II <br /> <br />LJ <br /> <br />II <br /> <br />Fonn PUR 7068 (Rev. 06/11/92) <br /> <br />00402-2 <br /> <br />03-4138.8 <br /> <br />LJ <br />