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I ' 6 . Based on information and belief, the statement which I have marked below is true in relation to the ent ty submitting this sworn statement. ( Indicate which statement applies . ) Neither the entity submitting this sworn statement, nor any of its officers . directors , executives , partners . shareholders , employees , members , or agents who are active in the management of the entity , nor any affiliate of e entity has 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 its officers , directors , executives , panne s , shareholders , employees , members , or agents who are active in the management of the entity, or an affiliate oft e entity has 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 its officers , directors , executives , partners , shareholders , employees , members , or agents who are active in the management of the entity, or an affiliate oft e entity has been charged with and convicted of a public entity crime subsequent to July 1 , 1989 . However, there his been a subsequent proceeding before a Hearing Officer of the State of Florida. Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the enti submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order. ) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FO THE PUBLIC ENTITY IDENTIFIED IN ARTICLE 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTIT ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR WHICH IT IS FILED . I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLI ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUN PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE f 14 THE INFORMATION CONTAINED IN THIS FORM. (Signature) Sworn to and subscribed before me this i day of 1 a_& Personally known t7 o e OR Produced identification Notary Public - State of �l L fr /s /;`/w ly My commission expires (Type of identification ) l f1 I C /� (Printed typed or stamped commissioned name Of notary public . ) Form PUR 7068 (Rev. 06/ 11 /92 ) indianrivercontract4001 .doc Page 25 of 25 Document last printed 05/ 18/00 10: 39 AM