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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, or an <br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. <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, or an <br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. <br />However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of <br />Administrative Hearings 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 was not in the <br />public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy <br />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 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. <br />I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING <br />INTO 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 />00456-3 <br />