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8 . Based on information and belief, the statement which I have marked below is true in relation to the e tity submitting this sworn statement. (Please indicate which statement applies ) to the entity submitting this sworn statement , nor any officers , directors , executives , partners , shareholders , employees , members or agents who are active in management of the entity , nor any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July I , 1989 . ' The entity submitting this sworn statement , or one or more of the officers , directors , executives , partners , shareholders , employees , members or agents who are active in management of the entity , or an affiliate of the entity has been charged with , and convicted of, ' a public entity crime subsequent to July I , 1989 , and ( Please indicate which additional statement applies ) ' There has been a proceeding concerning the conviction before a hearing officer of the State of Florida , Division of Administrative Hearings . The final order entered by the hearing officer did not place the person or affiliate on the convicted vendor list . (Please attach a copy of the final order) The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a hearing officer of the State of Florida , Division of Administrative Hearings . The final order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. ( Please attach a copy of the final order) The person or affiliate has not been placed on the convicted vendor list. ( Please describe any action taken by , or pending with , the Department of General Services ) 1 Signature : 22Da ' 04 '7 at e : � -� STATE OF r lQi COUNTY OF `f1 Personally appeared before me , the undersigned authority, C` ArMrA ho,) 6N� ' wh after first bei g swor by me , affixed his/her signature in the space provided above on this 'Z day of VsA 20 ' Notary Flublic , State at large 4Y P��: Alysa A Comfort � : My Commission Expires : MYCOMMISSIOf�# CC 09615 EXPIRES ',' ' • • • ' d 26, 2004 NRNDER TNRU TROY PAIN INSURANCE: INC i ' * * END OF SECTION 00450 - 2 0378-00450 - Public Entity Crimes Affidavit FAEngineering\Capital Projects\0378-26th Street Bridge\0378-26th Street Bridge CONTRACT DOC\0378-00450 - Public Entity Crimes Affldevit.doc Rev. 05/01