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executives , partners, shareholders , employees , members and agents who are active in <br /> 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 /> Neither the entity submitting this sworn statement , nor any officers , directors , executives , <br /> partners , shareholders , employees , members or agents who are active in management of the <br /> entity , nor any affiliate of the entity have been charged with and convicted of a public entity <br /> crime subsequent to July I , 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 I , 1989 , and ( Please indicate which additional statement <br /> 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 of <br /> the final order) <br /> The person or affiliate was placed on the convicted vendor list. There has been a <br /> subsequent proceeding before a hearing officer of the State of Florida , Division of <br /> Administrative Hearings . The final order entered by the hearing officer determined that it was in <br /> the public interest to remove the person or affiliate from the convicted vendor list. ( Please <br /> attach a copy of the final order) <br /> The person or affiliate has not been placed on the convicted vendor list. ( Please <br /> . describe any action taken by, or pending with , the Department of General Services ) <br /> Signature : ki. i3 Date : 0 C i 1 `3 Z UC <br /> STATE OF i= tar � � ti <br /> COUNTYOF <br /> Personally appeared before me , the undersigned authority ,(, ,jJ <br /> LLn. gJoLG� • , <br /> who after first being sw: rn y me , affixed his/her signature in the space provided abov n this <br /> 1 :; day of C9c '� , 2004 . <br /> De"' 1 <br /> NotarV Public, State at large <br /> My Commission Expires : <br /> ."'"':'r' AGNES A. H7DO <br /> Kt <br /> MY COMMISSION206636• % EXPIRES: Ju07 <br /> k�' ^�a`'; Yardea T ru Notary n,a1c UrNerw,lters <br /> END OF SECTION <br /> • <br /> IRC OPERATIONS COMPLEX 00450 — Public Entity Crimes Affidavit <br /> 00450 - 2 <br />