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X Neither the entity submitting this sworn statement, nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , nor any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1 , 1989 . The entity submitting this sworn statement, or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1 , 1989 , AND ( Please indicate which additional statement applies . ) There has been a proceeding concerning the conviction before a hearing officer of the State of Florida , Division of Administrative Hearings . The final order entered by the hearing officer did not place the person or affiliate on the convicted vendor list . ( Please attach a copy of the final order. ) The person or affiliate was placed on the convicted vendor list . There has been a subsequent proceeding before a hearing officer of the State of Florida , Division of Administrative Hearings . The final order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list . ( Please attach a copy of the final order. ) The person or affiliate has not between placed on the convicted vendor list . ( Please describe any action taken by or pending with the Department of General Services . ) ANDY EASTON & ASSOCIATES Consultant ' s Company Name Authorized Signature — Manual 1914 Fannie Drive FL 32303 Andy Easton Physical Address Authorized Signature — Typed Same Grant Administrator Mailing Address Title ( 850) 445 -7829 (850) 386-2605 Phone Number FAX Number 20