04/18/1990
EXTENSION OF CONTRACT, DATED FEBRUARY 7, 1989, FOR
THE MAINTENANCE OF THE MONROE COUNTY TELEVISION
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WHEREAS, a contract was entered into by the ~~~e Countr
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Board of County Commissioners constituting the gove~ing bRPY ~
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the Monroe County Special Taxing District for t~ .te1e~si~
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translator system, hereinafter referred to as the Coun~ a~
TRANSLATOR SYSTEM INSTALLATIONS
Carmelita T. Gossard d/b/a C & M Electronics Co., hereinafter
referred to as the Contractor, whose mailing addresses is P. O.
Box 10, Summerland Key, Florida 33042; and
WHEREAS, the contract was extended for a period of sixty
(60) days, by the Board of County Commissioners at their January
24, 1990 meeting, and further extended for a period of one year
at the February 13, 1990 Board of County Commissioners meeting.
NOW, THEREFORE, the above-mentioned contract is hereby
extended for one (1) year and sixty (60) days until April 7,
1991.
All other provisions in the contract remain in full effect.
A copy of the contract dated February 7, 1989, is attached.
(SEAL)
AttestPANNY L. KOLHAGE, Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
of-LrL
By ~
Mayor/Chairman
D ate : Ap r i 1 18, 1 990
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CARMEL IT . O's a
C & M ELECTRONICS CO.
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Witnesses
AI'MOViD AS TO FORM
AND LEGAL SUFFICIENCY.
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SWO~ STATEMENT UNDER SECTlOf'\: 287.133(3)(a),
FLORIDA STATUTES. ON punuc ENTIn' CRIMES
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THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER
AUtHORIZED TO ADMINISTER OATHS.
y.
1.
This sworn statement is submitted with Bid, Proposal or Contract No.
fur MRintenance of Translator Electronic Equipment
This sworn statement is submitted by C&M Electronics
[name of entity submitting sworn statement]
Post Office Box 10, Summerland Key, Fl 33042
2.
whose business address is
and
(if applicable) its Federal Employer Identification Number (FEIN) is
. .
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
3.
My name is
l)u-O~-011257-32
Carmel~ta T. Gossard
[please print Dame of individual signing]
.)
statement:
and my relationship to the
entity named above is
Prpc::inpnt
4. I understand that a "public entity crime" as defined in Paragraph 287.J.33(1)(g), Florida Statutes.
means a violation of any state or. federal law by a person with respect to and directly related to the
transaction of business with any public entity or with an agency or political subdivision of any other
state or with the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state
or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
5. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes.
means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of
guilt, in any federal or state trial court of record relating to charges brought by indictment or
information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty
or nolo contendere.
6. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes. means:
1. A predecessor or successor of a person convicted of a public entity crime: or
2. An entity under the control of any natural person who is active in the management of the
entity and who hell: been convicted of a public entity crime. The term "affiliate" includes those
officers, directors, executives, panners, shareholders, employees, members, and agents who are active
in the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
market value under an arm's length agreement, shall be a prima facie case that one person controls
another person. A person who knowingly enters into a joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months shall be considered an
affiliate. .
7. A 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 any state or of the United States with the legal
power to enter into a binding contract and which bids or applies to bid on contracts for the 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 in management of an entity. .
8. 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 ~wor:!l 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 crinle
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, AMQ. [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 afftliate on the convicted vendor list. [Please
attach a copy of the Onal 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 afftliate from the convicted vendor lisL
[Please attach a copy of the Onal order.]
_ The person or affiliate has not been placed on the convicted vendor list. [please
describe llny action taken by or pending with the Department or General Services.]
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Carmelita T. GORRRrn
[signatpre]
Date: 3/31/~0
STATE OF
COUNTY OF
Florida
Monrop
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Carmelita T Gossard
who, after first being sworn by me, affixed his/her signature
[name of individual signing]
in the space provided above on this
31st day of March .19 90
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NOTARY PUBUC o'.
My commission expires:
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For;n PUR 7068 (Rev. 11/89)
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