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<br />SWORN STATEMENT PURSUANT TO SECTION 287. 133(3)(a)
<br />FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
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<br />THIS FORi\'! MUST BE SIG:\"ED Al\D SWOR.J\i TO IN THE PRESENCE OF A NOTARY PCBLIC OR OTHER
<br />OFfICIAL AUTHORIZED TO ADMINISTER OATHS,
<br />
<br />I, This sworn statement is suhmilled to
<br />
<br />City of Su_nI],y_,.J:_sle_s_..Beach
<br />
<br />by
<br />for
<br />
<br />Oscar Gon<':,!'3-Je;?;
<br />
<br />Media Rgl!'3-Xions Group. LLC.
<br />
<br />whose business address is 18001 Old Cutler Road. Suite 40_L-._',_,____,_______
<br />
<br />Village of,J~l~~tto Bay, FL. 33157
<br />
<br />and (if applicable) its Federal Employer Identification Number (FEIl\) is 20-0118620
<br />(IF the entity had no FEIl\, include the Social Security l\umber of the individual signing this sworn statement:
<br />
<br />.
<br />
<br />2, I understand that a "public entity crime" as defined in Paragraph 287,133(l)(g), Florida Statutes, means a violation of
<br />any state or federal law by a person with respect to and directly related to the transaction of business v.,[th any public
<br />entity or with an agency or political subdivision of any other statc or or the united States, including, but notlimiled LO,
<br />any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any
<br />other state or of the Cnited States and involving antitrust fraud. theft. bribery_ collusion, racketeering, conspiracy, or
<br />material misrepresentation,
<br />
<br />3. 1 understand that "convicted" or "conviction" as definc:=d in Paragraph 287,1 33(l)(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 trial
<br />court of record relating to charges brought by indictment or information after July j, 1989, as a result of a jury verdict,
<br />nonjury triaL or cntry of a plea of guilty or nolo contenders,
<br />
<br />4 I understand that an "affiliatc" as defined in Paragraph 287_ I 33(1)(a), Florida,Statute~, means:
<br />
<br />a. A prcdecessor or successor of a person convicted of a publ ic entity crime: or
<br />
<br />5.
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<br />b. An entily under the control of any natural person who is active in the management of the entity and who has been
<br />convicted of a public entity come, The term '"affiliate" incllldc:=s those officers, directors, executives. partners.
<br />shareholders, employees, members, and agents who are active in the management of an affiliate, The ownership
<br />by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income
<br />among persons when not for fair market value under an arm's length agreement. shall be a prima facie case that
<br />one person controls another person, A person who knowingly cnters intu a joint venture with a person who has
<br />been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate,
<br />I understan that a "person" as defined in Paragraph 287,133(1)(e), Florida Statutes, means any natural person or entity
<br />organized der the laws of any Statc or of the United States with the legal power to enter into a binding contract and
<br />which bi s applies to bid on <:ontraclS for the provision of goods or services let by a public entity, or which
<br />otherwis sacts or applies to tran,;act business with" public entity. The term "person" includes those ofticers.
<br />~;~:~m. 'wli.c;, p,n"". ,h,,,ho]dee>, emp]oy'~;. membg ,,'" ,gent Wh01';V' ;" """gemen' of",>
<br />
<br />
<br />_W ().t7v h2, ______
<br />(Primed or Typed Legal Name of Attiant)
<br />
<br />
<br />Osc~r GODzalez....___ L
<br />
<br />WiJ,l.:ie Wang ~ \.~~ ~ Notary Seal:
<br />Notary', !\ame Printed. Stamped 01 Typed
<br />
<br />Personally Known: _____u_ or Produced Identification LIdelllificatiOl1 Produced _n..tL~Y-~'
<br />
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<br />
<br />State of Florida County of Miami-Dade
<br />Sworn to and subscribed be{orc me this 24th day of
<br />
<br />April
<br />
<br />, 2007 by
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<br />
<br />Page 8 of <)
<br />RFQ 07-03-01 Engineering Srvs Bridge Revised (Addendum, I)
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