Laserfiche WebLink
<br />II <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />i <br />i <br />i <br />i <br />I <br />!i <br />Ii <br />i <br />I <br /> <br />6. Based on information and belief, the statement which I have marked below is true in relation to <br />the entity submitting this sworn statement. [Indicate which statement applies] <br /> <br />Neither the entity submitting this sworn statement, nor any of its officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, nor any affiliate of the entity has been charged with and convicted of a <br />public entity crime subsequent to July 1, 1989. <br /> <br />The entity submitting this sworn statement, or one or more of its officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, nor any affiliate of the entity has been charged with and convicted of a <br />public entity crime subsequent to July 1, 1989. <br /> <br />The entity submitting this swo'rn statement, or one or more of its officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in the <br />management of the entity, nor any affiliate of the entity has been charged with and convicted of a <br />public entity crime subsequent to July 1, 1989. However, there has been a subsequent <br />proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings <br />and the Final Order entered by the Hearing Officer of the State of Florida, Division of <br />Administrative Hearings and the Final Order entered by the Hearing Officer determined that it <br />was not in the public interest to place the entity submitting this sworn statement on the convicted <br />vendor list. [attach a copy of the final order] <br /> <br />Sworn to and subscribed before me this <br /> <br />Personally known <br /> <br />~ <br /> <br />OR Produced identification <br /> <br />(Type of identification) <br /> <br /> <br />05/08 Final Version <br /> <br />00402-2 <br /> <br />05-4893 <br />