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entity submitting this. sworn statement on the convicted vendor list (attach a copy <br />of the final order). <br />I UNDERSTAND THAT THE .SUBMISSION OF THIS FORM TO THE <br />CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN <br />PARAGRAPH ONE ABOVE IS: FOR THAT PUBLIC ENTITY ONLY AND, <br />THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE <br />CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT <br />I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO <br />ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD <br />AMOUNT PROVIDED IN SECTION 287.017 FLORIDA STATUTES FOR <br />CATEGORY TWO OF ANY CHANGE IN THE INFORMATION <br />CONTAINED IN THIS FORM. <br />TLC Diversified, Inc. <br />(Signature) <br />Dalas Lamberson, Vice President <br />Sworn to and subscribed before me this 18`t' day of May, 2021 <br />Personally luno fn tonne. <br />Notary Public — State of Florida <br />Linda Kay Moore <br />Notary Stamp: <br />j4pre•;. UNDAKAY MOORE <br />? Notary Public - State of Florida <br />Commission k GG.963661 <br />�? or My Comm. Expires Mar 24, 2024 <br />Bonded through National Notary Assr.. <br />186 <br />