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r� <br /> INDIAN RIVER COUNTY RECREATION MULTI PURPOSE BUILDING I I 9 � <br /> 00650-1 <br /> 8. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this <br /> sworn statement: Indicate which statement applies . <br /> X Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, share <br /> holders, employees, members, or agents who are active in the management of the entity, not any affiliate of the entity <br /> has been charged with and convicted of a public entity crime subsequent to July 1 , 1989 . <br /> The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, <br /> employees, members, or agents who are active in management of the entity, or an affiliate of the entity has been <br /> charged with and convicted of a public entity crime subsequent to July 1 , 1989, AND Indicate which additional <br /> statement applies. <br /> There has been a proceeding concerning the conviction before a hearing officer of the State of Florida, Division of <br /> Administrative Hearings. The final order entered by the hearing officer did not place the person or affiliate on the <br /> convicted vendor list. Attach a copy of the final order. <br /> The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a <br /> hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing <br /> officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. <br /> Attach a copy of the final order. <br /> The person or affiliate has not been placed on the convicted vendor list. Describe any action taken by or pending with <br /> the State of Florida, Department of General Services. <br /> (Signature) <br /> Date: 08-10-04 STATE OF FLORIDA COUNTY OF ALACHUA <br /> PERSONALLY APPEARED BEFORE ME, the undersigned authority, <br /> John V. Carlson, President <br /> who, after first being sworn by me, affixed his /her signature in the space provided above on <br /> this day of <br /> 20 <br /> NOTARY PUBLIC <br /> My commission expires : <br /> NOW <br /> PPI Construction Management Pon ikvar & Associates 49 <br />