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SWORN STATEMENT UNDER SECTION 105 . 08 , <br /> INDIAN RIVER COUNTY CODE , ON DISCLOSURE OF RELATIONSHIPS <br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC <br /> OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS , <br /> 1 . This sworn statement is submitted with RFP No . 6067 for <br /> St . Peter' s Village of Excellence Institute for Girls <br /> 2 . This sworn statement is submitted by: St . Peter' s Human Services , Inc . <br /> (Name of entity submitting Statement ) <br /> whose business address is : <br /> 425. 0 . 38' Avenue , Vero Beach , FL 32967 and <br /> ( if applicable ) <br /> its Federal Employer Identification Number ( FEIN ) is 31 - 1480633 . <br /> ( If the entity has no FEIN , include the Social Security Number of the individual <br /> signing this sworn statement <br /> 3 . My name is Andrew Jefferson <br /> ( Please print name of individual signing ) <br /> and my relationship to the entity named above is President . <br /> 4 . 1 understand that an "affiliate " as defined in Section 105 . 08 , Indian River <br /> County Code , means : <br /> The term "affiliate " includes those officers , directors , executives , partners , <br /> shareholders , employees , members , and agents who are active in the <br /> management of the entity . <br /> 5 . 1 understand that the relationship with a County Commissioner or County <br /> employee that must be disclosed as follows : <br /> Father, mother , son , daughter, brother, sister, uncle , aunt , first cousin , <br /> nephew, niece , husband , wife , father-in -law, mother- in -law , daughter- <br /> in - law , son - in - law , brother-in - law , sister- in -law, stepfather, stepmother, <br /> stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, <br /> grandparent , or grandchild . <br /> XII <br />