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<br />and agents who are active in management of an entity.
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<br />6.
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<br />Based on information and belief, the statement which I have marked below is true in
<br />relation to the entity submitting this sworn statement. [Indicate which statement applies]
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<br />'-I Neither the entity submitting this sworn statement, nor any of its officers, directors,
<br />e~ves, 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
<br />convicted of a public entity crime subsequent to July 1, 1989.
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<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
<br />convicted of a public entity crime subsequent to July 1, 1989.
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<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
<br />convicted of a public entity crime subsequent to July 1, 1989. However, there has been a
<br />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
<br />Florida, Division of Administrative Hearings and the Final Order entered by the Hearing
<br />Officer determined that it was not in the public interest to place the entity submitting this
<br />sworn statement on the convicted vendor list. [attach a copy of the final order]
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<br />II
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<br />I UNDERSTANDJtiAT THE _SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR
<br />THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY
<br />ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN
<br />WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC
<br />ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT
<br />PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE
<br />IN THE INFORMATION CONTAINED IN THIS FORM.
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<br />- [signature]
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<br />Sworn to and subscribed before me this -l ~ ~'"
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<br />day of C? c:.. '\1Jo<::;;'-
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<br />, 20,Q5.
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<br />Personally known
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<br />Notary Public - State of ~ L) r \, ot c
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<br />OR Produced identification
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<br />(Type of identification)
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<br />.. "~~~r~. RYAN SPRADUN
<br />My commiSSion ex I~I':'~ MYCOMMISSION#BB920502
<br />. ~.:;:._ . .'&: EXPIRES: August 27. 2013
<br />-/1 ".r.,i~~" Bonded Thru Notary Public Underwriters
<br />(rinte ped or st
<br />commissioned name of notary public)
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<br />Form PUR 7068 (Rev. 06/11/92)
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<br />09/09
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<br />00402-2
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<br />03-4122.F
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