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Fort Walton Beach Council agenda — 08-14-12 regular — reading text
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length agreement, shall be a prima facie case that one person controls
another person. A person who was knowingly convicted of a public entity crime, in
Florida during the preceding 36 months shall be considered an affiliate.
Page 9 of 55 PaeketRg. 49
83.
I understand that a " person" as defined in Paragraph 287. 133( 1)( e), Florida Statutes, means any
natural person or entity organized under the laws of the state or of the United States with the
legal power to enter into a binding contract for provision of goods or services let by a public
entity, or which otherwise transacts or applies to transact business with a public entity. The term
person" includes those officers, directors, executives, partners, shareholders, employees,
members, and agents who are active n management of an entity.
Based on information and belief, the statement which I have marked below is true in relation to
the entity submitting this sworn statement. ( Please indicate which statement applies.)
Neither the entity submitting this sworn statement, nor any officers, directors, executives, o
8
partners, shareholders, employees, members, or agents who are active in management of the
entity, nor affiliate of the entity have been charged with and convicted of a public entity crime n
subsequent to July 1, 1989.
a
a
The entity submitting this sworn statement, or one or more of the officers, directors, E
executives, partners, shareholders, employees, members, or agents who are active in management m
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. ( Please attach a copy of the final order.) a
U
The person or affiliate was placed on the convicted vendor list. There has been a o
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 o
public interest to remove the person or affiliate from the convicted vendor list. ( Please attach a
m
copy of the final order)
The person or affiliate has not been placed on the convicted vendor list. ( Please describe m
any action taken by, or pending with, the Department of General Services.)
Signature)
Date)
STATE OF COUNTY OF:
PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first
being sworn by me, affixed his /her signature at the space provided above on this day
2012, and is personally known to me, or has
as identification.
Notary Public
My Commission expires
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