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There has been a conviction of a public entit a Bidder or <br /> Contractor, or an office ';c}iie r executive , partner, sh er, employees , member or agent <br /> of the Bidder or Contractor who is acti agement of the Bidder or Contractor or an <br /> affiliate of the Bidder or Contra I etermination made pursuant to Section <br /> 287 . 133 (3 ) by or a Division of Administrative Hearings tha I ' ' the public interest <br /> for th of the convicted person or affiliate to appear on the convicted vendor <br /> name of the convicted person or affiliate is . A copy of the order of the <br /> Division of Administrative Hearings is attached to this statement. <br /> ( Draw a line through Paragraph 7 if Paragraph 6 above applies ) <br /> AWRENCE MYE <br /> Sworn to and subscribed before mein the state and county first mentioned above on tK6 21 <br /> day of MAY 2003 <br /> 00� (affix seal ) <br /> N ar Public <br /> Jean Carbano <br /> =.: r MY COMMISSION # DD180550 EXPIRES <br /> a March 8, 2007 <br /> >tjiF ty <br /> BONDED THRU TROY FAIN INBURANC; INC <br /> My commission expires <br /> 00310 - 10 <br /> F :\Utilities\UTILITY - ENGINEERING\Projects - Assessment Projects\West Side Subdivision - UCP#2177\Bid docs\specs\00310 Bid <br /> Form .doc <br />