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<br />otherwise transacts or applies to transact"business with a public entity. The term "person"
<br />includes those officers, directors, executives, partners, shareholders,
<br />employees, members,and agents who are active in management of an entity.
<br />8. Based -,on mformation`arid belief, the statement which i have marked below is true in relation to
<br />the entity submitting this s%orn'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 activeiin management of the entity„
<br />nor any affiliate of the entity have, been charged with and convicted of a .public entity`.crime
<br />subsequent to July 1, 1989.
<br />-_ Th'e entity submiiting, this sworn statement, or, one or more of the -officers, directors,
<br />.� executives, partners, shareholders; employees, members or agents who'are,active in management
<br />of the entity, or an affiliate ofabe�entity has been charged with, and convicted of, a public entity
<br />x crime.subsequenvto July 1, 1989, and (Please indicate which additional statement applies)
<br />There has-been•a proceeding concerning the conviction before a hegring"officer of the State
<br />.. of Florida, Division of Administrative Hearings, The final order entered by the hearing officer did
<br />not place the person or affiliate on the convicted vendor, list.(Please attach. a copy of the final
<br />order)
<br />~ The person' or affiliate was placed' on the convicted vendor list. 'There'has been a
<br />-subsequent proceeding before a'hearing ofl,76er of the State of Florida, Division of Administrative.
<br />Hearings. {The final order entered -by the hearing officer determined that it was in the public
<br />interest to remove the person or aPfiliate,from the convicted vendor list. (Please attach a copy of
<br />the final'order)
<br />The, or`, affiliate has not b en .placed on the convicted vendor list. (Please describe
<br />any action, taken or pending with, th epartment of General Services)
<br />Signature:
<br />µ t `bate:
<br />7 7 96
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<br />STATE OF Florida ¢
<br />County OF Martin
<br />Personally appeared before me, theundersigned authority; Joseph'*G. Kiliriski who
<br />after first being sworn by me, affixed hi"er signature in the space provided above on
<br />this_ .1� _day of Jul ,19�i�,... Y; .
<br />~'. YAIRICIA RCBINSU�4 • n ; g ; '" ` '
<br />' My C.,.,h bn C039W12 a
<br />Notary Public, State at large it >!c ku«� 1°W
<br />nu ' .
<br />My Commission Expires: ,; No
<br />S' 'fit � •� 'rf. ,' - _
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