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<br />~ <br /> <br />5. I understand that a "person" as defined in Paragraph 287. 133(l)(e), Florida Statutes; means any <br />natural person or entity organized under the laws of any state or of the United States with the <br />legal power to enter into a binding contract and which bids or applies to bid on contracts for <br />the provision of goods or services let by a public entity, or which otherwise transacts or applies <br />to transact business with a public entity, The term "person" includes those officers, directors, <br />executives, partners, shareholders, employees, members, and agents who are active in <br />management of any entity. <br /> <br />6. Based on information and belief, the statement which I have marked below is true in a <br />relation to the entity submitting this sworn statement. (Please indicate which one (1) of the <br />following three (3) statements is applicable.) <br /> <br />1- (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 <br />management of the entity, or any affiliate of the entity has been charged with and convicted of a <br />public entity 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 <br />management of the entity, or any affiliate of the entity has been charged with and convicted of a <br />public entity 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 <br />management of the entity, or agents who are active in management of the entity, or any affiliate <br />of the entity has been charged with and convicted of a public entity crime within the past 36 <br />months. However, there has been a subsequent proceeding before a Hearing Officers of the State <br />of Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer <br />determined that it was not in the public interest to place the entity submitting this sworn <br />statement on the convicted vendor list. (Attached is a copy of the 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 <br />FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH <br />DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE <br />PERIOD OF THE CONTRACT ENTERED INTO , WHICHEVER PERIOD IS LONGER. I <br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY <br />PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT <br />PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR THE CATEGORY TWO OF <br />~GE IN TIfE INFORMATION CONTAINED IN THIS FORM. <br /> <br />-- <fr ::Z::>4 ~ TnnothyD.II.."y <br />SI NATURE OF AFF (Prmted or Typed Legal Name of AffIant) <br />