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<br />')
<br />
<br />market value under an arm's length agreement, shall be a prime facie case that one J1erson
<br />controls another person. A persoll who knowingly enters into a joint venture with CJ persun who
<br />has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br />considered an affiliate.
<br />
<br />11.5.
<br />
<br />I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
<br />person or entity organized under the laws of any state or of the United States with the legal power to
<br />enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or
<br />services let by a public entity, or which otherwise transacts or applies to transact business with a public
<br />entity. The term "persons" includes those officers, directors, executives, partners, shareholders.
<br />employees, members, and agents who are active in management of any entity.
<br />
<br />J
<br />
<br />Based on information and belief, the statement which I have marked below is true in relation to the entity
<br />submitting this sworn statement. (Indicate which statement applies.)
<br />
<br />Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners,
<br />shareholders, employees, members, or agents who are active in the management of the entity, nor any
<br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
<br />1989.
<br />
<br />The entity submitting this sworn statement, or one or more of its officers, directors. executives, partners,
<br />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,
<br />1989.
<br />
<br />\
<br />,
<br />
<br />The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br />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,
<br />1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of
<br />Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the
<br />State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
<br />determined that it was not in the public interest to place the entity submitting this swom statement on the
<br />convicted vendor list. (Attach a copy of the final order.)
<br />
<br />I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
<br />PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (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. I
<br />ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
<br />A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
<br />STATUTES, FOR CATEGORY TWO OF ANY, CH GE IN THE INFORMATION CONTAINED IN THIS FORM.
<br />
<br />By:
<br />
<br />
<br />(Printed Name)
<br />President
<br />(Title)
<br />
<br />L Sworn to ~d subscribed before me this ~ day of ~
<br />a~rq {-'U- L- . _ 6~
<br />
<br />(AFFIX NOTARY STAMP HERE) _
<br />
<br />",20~. by
<br />
<br />Signature: Notary Public - State of Florida
<br />
<br />Personally Known
<br />
<br />/
<br />
<br />Print or Type Commissione
<br />
<br />
<br />~t>1-f 'II~. N t p
<br />~ t ~ 0 ar'j . ublic State of Florida
<br />RemlQIO Garcia
<br />; c;\ '. J My"Commission EE060509
<br />~1-o,,:O~ Expires 01/31/2015
<br />
<br />
<br />OR Produced Identification
<br />
<br />Type of Identification Produced
<br />
<br />DL-
<br />
<br />1011998
<br />
<br />3of7
<br />
<br />LAURA M. PEREZ AND ASSOCIATES, INC
<br />
<br />RFQ #12-04-02
<br />
<br />PAGE 78
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