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<br /> Imarket value under an arm's length agreement, shall be a prime facie case that one person
<br /> O controls another person. A person who knowingly enters into a joint venture with a person who
<br /> has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br /> ®
<br /> considered an affiliate.
<br /> O 5. I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
<br /> 0 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
<br /> ® services let by a publicContract entity, orand whichwhich otherwiseBidsor transactsappliestoBid or on appliesContracts to transactforthe businessprovision withof agoods publicor
<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 /> ® 6. 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 /> 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 /> ill
<br /> The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
<br /> 0 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 /> • 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 sworn statement on the
<br /> ® convicted vendor list. (Attach a copy of the final order.)
<br /> 0 - -- 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 PUBLI ENTITY PRIOR TO ENTERING INTO
<br /> A CONTRACT IN EXCESS OF THE THRESHOLD AMOUR PR/ ,aED IN SECTION 287.017, FLORIDA
<br /> 0 STATUTES, FOR CATEGORY TWO OF ANY, CHA GE IN/7 IN "' ATION CONTAINED IN THIS FORM.
<br /> 0 By:
<br /> Ile Aid / Ali
<br /> 0 (Signature
<br /> ® itnrothy \ P. ►
<br /> ® (Printed Name)
<br /> O (Title)
<br /> ®1 Sworn to and subscribed before me this tom day of ] L4 bQ. , 20 11 , by
<br /> 0 l�
<br /> (A •l }.l ANY �ALIFI ) ^1 0 l E 1 l�d D2
<br /> , .,: ;= MY COMMISSION Y FF 191639
<br /> ® .:,1..:;a: EXPIRES:February 26,2019 n. �Mt ic—State of Florida
<br /> 4, ii,:M'e' Banded Thru Notary Public UnderrrtSiders g ril
<br /> -
<br /> AITLAlai
<br /> Prin . 1 rr•. missione. Name
<br /> Personally Known / OR Produced Identification
<br /> 1110
<br /> Type of Identification Produced
<br /> II10/1998 3 of 7
<br /> 6
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