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SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
<br />THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br />OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
<br />This swom statement is submitted toCITY OF SUNNY ISLES BEACHby WILLIAM H. GRIFFIN
<br />for INTERNATIORAL SIGN & DE= CORP.
<br />whose business address is L STREET, LARGO, 33777
<br />_ and (if applicable) its
<br />Federal Employer Identification Number (FEIN) is (IF the entity had no FEIN, include the Social
<br />Security Number of the individual signing this sworn statement: FEIN #59-1683519
<br />I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
<br />violation of any state or federal law by a person with respect to and directly related to the transaction of business
<br />with any public entity or with an agency or political subdivision of any other state or with the United States,
<br />including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or
<br />an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft,
<br />bribery, collusion, racketeering, conspiracy, or material misrepresentation.
<br />3. I understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding
<br />of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state
<br />trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of
<br />a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere.
<br />4. I understand that an "affiliate" as defined in Para. 287.133(I)(a), Florida Statutes, means:
<br />A predecessor or successor of a person convicted of a public entity crime; or
<br />1 Any entity under the control of any natural person who is active in the management of the entity and
<br />who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors,
<br />executors, partners, shareholders, employees, members, and agents who are active in the management
<br />of an affiliate. The ownership by one person of shares constituting a controlling interest in another
<br />person, or a pooling of equipment or income among persons when not for fair market value under an
<br />arm's length agreement, shall be a prime facie case that one person controls another person. A person
<br />who knowingly enters into a joint venture with a person who has been convicted of a public entity
<br />crime in Florida during the preceding 36 months shall be considered an affiliate.
<br />I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or
<br />entity organized under the laws of any state or of the United States with the legal power to enter into a binding
<br />Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public
<br />entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons"
<br />includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are
<br />active in management of any entity.
<br />6. Based on information and belief, the statement which I have marked below is true in relation to the entity
<br />submitting this sworn statement. (Indicate which statement applies.)
<br />X Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any
<br />affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.
<br />00456-2
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