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` / Neither the entity submitting this sworn statement, nor any of its officers , directors , executives , partners , shareholders , employees , members , or agents who are active in the management of the entity , or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months . _ The entity submitting this sworn statement, or one or more of its officers , directors , executives , partners , shareholders , employees , members , or agents who are active in the management of the entity , or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months . AND ( Please indicate which additional statement applies) . The entity submitting this sworn statement, or one or more of its officers , directors , executives , partners , shareholders , employees, members , or agents who are active in the management of the entity , or agents who are active in the management of the entity , or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months . However, there has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list . (Attached is a copy of the final order) . I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 ( ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROU G1-1 .DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT ENTERED INTO , WHICHEVER PERIOD 1S LONGER . I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED fN SECTION 287 . 017 , FLORIDA STATUTES , FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM . SuI�tol , CFO STATE OF LOUISIANA PARISH OF EAST BATON ROUGE Sworn and subscribed before me this /.S day of ,� Y 2011 by Joel K . Scales who is Personally known to me Or who produced identification - (Type of Identification ) ( Signature) Notary PuNic , Louisiana State at i ,arge. Daniel B . Davis , Esq . (Printed , typed or stamped commissioned name of notary public) My commission expires Upon Death ( SEAL) LO OFFICIAL SEAL 4 DANIEL B . DAVIS NOTARY ID NO . 88213 LOUISIANA BAR ROLL NO , 30141 � * STATE NOTARYPUBLICNA My ComMlsslon Ip for I., if!' 37