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(07-07-02) General Architectural Services
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Last modified
2/23/2011 1:41:49 PM
Creation date
2/23/2011 1:32:11 PM
Metadata
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CityClerk-Bids_RFP_RFQ
Project Name
Prof. General Architectural Svcs.
Bid No. (xx-xx-xx)
07-07-02
Project Type (Bid, RFP, RFQ)
RFQ
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<br />o <br /> <br />o <br /> <br />o <br /> <br />6. Based on information and belief, the statement which I have marked below is true in a relation to <br />the entity submitting this sworn statement. (Please indicate which one (1) of the following three <br />(3) statements is applicable.) <br /> <br />~ (1) 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 management <br />of the entity, or any affiliate of the entity has been charged with and convicted of a public entity <br />crime within the past 36 months. <br /> <br />_(2) 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 management <br />of the entity, or any affiliate of the entity has been charged with and convicted of a public entity <br />crime within the past 36 months. <br /> <br />_(3) 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 management <br />of the entity, or agents who are active in management of the entity, or any affiliate of the entity has <br />been charged with and convicted of a public entity crime within the past 36 months. However, there <br />has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of <br />Administrative Hearings and the Final Order 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. <br />(Attached is a copy ofthe final order.) <br /> <br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING <br />OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR <br />THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 <br />OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF TIlE <br />CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND <br />THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A <br />CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, <br />FLORIDA TATUTES FOR THE CATEGORY TWO OF ANY CHANGE IN THE <br />INFO N NTAINED IN THIS FORM. <br /> <br /> <br />~CflS ~~z../J>4ftr <br /> <br />(printed or Typed Legal Name of Affiant) <br /> <br />At6u31 <br /> <br />day of <br /> <br />. 2007 by <br /> <br /> <br />Notary's Name P . ted, Stamped or Typed <br />~y ~ or Produced !deutiticatiou <br />Identification Produced <br /> <br />#~YP{J,,<t. MARTHA GUERRA <br />'!l> ~~ MY COMMISSION # DC 333438 <br />""1'Ofl\.l)~ EXPIRES: June 28, 2008 <br />1-8Q0-3.NOTARY "l No:a,"! Discount Assoc. Co <br />
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