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s <br />May 25, <br />1999 <br />UNDERSTAND THAT THE SUBMISSION OF TIIIS'7ORM TO TIIE CONTRACTING OFFICER <br />FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH l ( ONE) ABOVE,. IS FOR TIIAT PUBLIC <br />ENTITY ONLY AND, THAT THIS FORM IS VALID '1'IIROUGII DECEMBER 31 OF THE <br />CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND 'I'IIAT I AM REQUIRED TO <br />r INFORM THE PUBLIC ENTITY PRIOR 'I'O ENTERING INTO A CONTRAC"I' IN EXCESS OF THE <br />THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY <br />TWO OF ANY CHANGE IN THE INFORMA'T'ION CONTAINED IN'1711S FORM. <br />date] <br />STATE OF F I O r t C <br />11 <br />I C) <br />COUNTY OF T r1C1Lt 1 y <br />PERSONALLY APPEARED BEFOP 110M, the unuh;iSigned authority, <br />name of individual signing] <br />who, after fust being sworn by me, affixed hislher signature in the space provided above on this <br />rc <br />day _19 <br />NOTARY PUBLIC <br />My commission expires: <br />Form PUR 7068 (Rev. 04/10/ 91) <br />P1-'(---1 <br />ORACE V.0Aq6^g*M <br />dy C0M%11S510N A CC 786017r?' <br />EXPIRF.S:Ocleber26.2002 <br />co,d.dTh rN ,,yPw cr, n:: n <br />signature] <br />i , /()lf1 <br />date] <br />STATE OF F I O r t C <br />11 <br />I C) <br />COUNTY OF T r1C1Lt 1 y <br />PERSONALLY APPEARED BEFOP 110M, the unuh;iSigned authority, <br />name of individual signing] <br />who, after fust being sworn by me, affixed hislher signature in the space provided above on this <br />rc <br />day _19 <br />NOTARY PUBLIC <br />My commission expires: <br />Form PUR 7068 (Rev. 04/10/ 91) <br />P1-'(---1 <br />ORACE V.0Aq6^g*M <br />dy C0M%11S510N A CC 786017r?' <br />EXPIRF.S:Ocleber26.2002 <br />co,d.dTh rN ,,yPw cr, n:: n