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7 . I understand that a "person" as defined in Paragraph 287 . I33 ( 1 )(c) , Florida Statutes, means
<br /> any natural person or entity organized under the laws of any state of the United States with
<br /> legal power to enter into a binding contract and which bids or applies to bid on contracts for
<br /> the provision of goods or services let by a public entity, or which otherwise transacts or
<br /> applies to transact business with a public entity. The term "person" includes those officers,
<br /> directors, executives , partners, shareholders , and employees, members and agents who are
<br /> active in 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 /> X Neither the entity submitting this sworn statement, nor any officers, directors,
<br /> executives , partners , shareholders , employees, members or agents who are active in
<br /> management of the entity, nor any affiliate of the entity have been charged with and convicted
<br /> of a public entity crime subsequent to July 1 , 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 1 , 1989 , and (Please indicated which additional
<br /> statement 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
<br /> of 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
<br /> in 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 place on the convicted vendor list. (Please
<br /> describe any action taken by, or pending with, the Department of General Services)
<br /> BY : I . D . ACNE CO . , LLC , GENERAL PARTNER
<br /> Signature : �- l �— Date : 6 / 8 / 04
<br /> PHI P D WAGNER , PESIDENT
<br /> STATE OF
<br /> COUNTY OF
<br /> Personally appeared before me , the undersigned authority,
<br /> � �, ► 1 ; � D , uagnef�
<br /> who after firsting sworn by me, affixed his / her signature in the space provided above on this -
<br /> day of �. -rr , 20..
<br /> �±--�, NOTARIAL SEAL
<br /> Notary Public , State t1arge ROSEMAP, y SOIgOTOR, Notary Public
<br /> Spring Twp ., Berks County, PA
<br /> My Commission Expires : My Commission Expires 7. 15-2007
<br /> F :\Purchasing\Bids\2003 -2004 FY ( 6000)\6080 Resurfacing on CR512 from SR 60 to Fellsmere Farms\6080 Bid Document . doc
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