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applies to transact business with a public entity. The term "person" includes those officers , <br /> ' directors , executives , partners, shareholders , and employees, members and agents who are <br /> active in management of an entity. <br /> ' 8 . Based on information and belief, the statement, which I have marked below, is true in relation <br /> to the entity submitting this sworn statement . (Please indicate which statement applies) <br /> X Neither the entity submitting this sworn statement, nor any officers , directors , <br /> executives, partners , shareholders, employees, members or agents who are active in <br /> management of the entity, nor any affiliate of the entity have been charged with and convicted <br /> 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 , <br /> ' executives , partners , shareholders , employees , members or agents who are active in <br /> management of the entity, or an affiliate of the entity has been charged with, and convicted of, <br /> a public entity crime subsequent to July 1 , 1989 , and (Please indicated which additional <br /> 1 statement applies) <br /> There has been a proceeding concerning the conviction before a hearing officer of the <br /> State of Florida, Division of Administrative Hearings . The final order entered by the hearing <br /> officer did not place the person or affiliate on the convicted vendor list . (Please attach a copy <br /> of the final order) <br /> The person or affiliate wasp laced on the convicted vendor list . There has been a <br /> subsequent proceeding before a hearing officer of the State of Florida, Division of <br /> iAdministrative Hearings . The final order entered by the hearing officer determined that it was <br /> in the public interest to remove the person or affiliate from the convicted vendor list . (Please <br /> attach a copy of the final order) <br /> ' Theerson or affiliate e has not been place on the convicted vendor list . (Please <br /> describe any action taken by, or pending with, the Department of General Services) <br /> Signature : Date : <br /> ' STATE OF FLORIDA <br /> COUNTY OF INDIAN RIVER <br /> ' Personally appeared before me, the undersigned authority, KENNETH B . AUSTIN , JR. <br /> who after first being sworn by me, affixed his / her signature in the space provided above on this _ <br /> 9TH day of JUNE , 2004 . <br /> Notary Public , State at large <br /> My Commission Expires : JUNE 16 , 2006 <br /> ' Page 35 of 52 <br />