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® market value under an arm's length agreement, shall be a prime facie case that one person
<br /> controls another person. A person who knowingly enters into a joint venture with a person who
<br /> 40 has been convicted of a public entity crime in Florida during the preceding 36 months shall be
<br /> 40 considered an affiliate.
<br /> ® 11.5. 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 /> 9 employees, members, and agents who are active in management of any entity.
<br /> ® 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity
<br /> 0 /submitting this sworn statement. (Indicate which statement applies.)
<br /> ® V 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 /> i 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.
<br /> ® _
<br /> 410 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 /> T! State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
<br /> 9 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 /> ® 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 /> 0 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, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
<br /> ® By: jJ�(,_ C 1 •
<br /> / /-C
<br /> ® . .___s--/-he L
<br /> (Signature) r f rreo(
<br /> (Printed Name)
<br /> ®
<br /> rYl(A4 c7/11 paitbter-
<br /> e (Title)
<br /> Sworn'to and subscribed before me this 3 ILL/day of_1,1e.e.C" , 20 r 2 , by
<br /> 0 Y s-'ON-o& i n Q OG
<br /> ® (AFFIX NO TA S.TAMP'HEREC `/ C- ;'
<br /> ® r tuKLW RODRIUUE3
<br /> i� ". 17d_4::public.State 0f Flcdda
<br /> ® p,eDD67B;32 Signature: Notary Public-State of Florida
<br /> .n• a
<br /> _,-roe Dr�if 1. 2013
<br /> e _� — Print or Type Commissioned Name
<br /> ® Personally Known OR Produced Identification //
<br /> 41 Type of Identification Produced =L 1/)
<br /> /
<br /> 9 10/1998 3 of 7
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