Laserfiche WebLink
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 /> L Neither the entity submitting this swom statement, nor an officers directors executives <br /> -- � tY 9 Y � , <br /> partners , shareholders , employees , members or agents who are active in management of the <br /> ' entity, nor any affiliate of the entity have been charged with and convicted of a public entity <br /> crime subsequent to July I , 1989. <br /> ' The entity submitting this swom statement, or one or more of the officers , directors , <br /> executives , partners , shareholders , employees , members or agents who are active in <br /> 4. 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 I , 1989 , and (Please indicate which additional statement <br /> applies) <br /> z 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 of <br /> -� the final order) <br /> The person or affiliate was placed on the convicted vendor list. There has been . a <br /> t . 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 in <br /> 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 placed on the convicted vendor . list. (Please <br /> ' describe any action taken by, or pending with , the Department of General Services) <br /> r <br /> r G f <br /> nt <br /> STATE OF <br /> z COUNTY OF a <br /> ' li Personally appeared beforeme, the undersigned authority, �0 t L— A 2n+ <br /> who after .first being swom by me , affixed his/her signature in the space- provided above on this <br /> { Iq '' n day of A %je u S r , 20Q;j* <br /> tBRANWISOLLINQB:R, <br /> ' x ry Public, Sta a at ( Notary public, State of Florida <br /> My Commission F�cpire ' My cornet . expires Aug: 12, 2005 <br /> Comm . No . DD048767 <br /> aDndtW Thru 8ervlo� Insurance Co pony Inc. <br /> � i <br /> * * END OF SECTION <br /> 0219-00450 - Public Entity Crimes Affidavit <br /> 00450 - 2 <br /> F.9En91neednMCapital Pm)ectsX021Mtrhing Stalan Trailhead1021910tchM Centrad b=%021M0450 - Public EnUty Comes Alfldavlt.doc Rev. 05101 <br />