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SECTION 00452 - SWORN STATEMENT UNDER SECTION 105 .08 . INDIAN RIVER
<br /> COUNTY CODE. ON DISCLOSURE OF RELATIONSHIPS
<br /> r THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC
<br /> OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS .
<br /> This sworn statement is submitted with Bid , Proposal or Project No . 0612 for Wabasso Beach
<br /> Park Restoration
<br /> 1 . This sworn statement is submitted by: Ocean Gate General Contractors , Inc .
<br /> (Name of entity submitting swom statement)
<br /> whose business address is: 2854 SE Federal Highway Stuart, FL 34994
<br /> and
<br /> (if applicable) its Federal Employer Identification Number (FEIN) is 651084099 (If
<br /> the entity has no FEIN , include the Social Security Number of the individual signing this
<br /> sworn statement ) •
<br /> 2 . My name is
<br /> Mark MacDonald
<br /> (Please print name of Individual signing)
<br /> and my relationship to the entity named above is Owner / President
<br /> 3 . 1 understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code ,
<br /> means:
<br /> The term "affiliate " includes those officers, directors, executives, partners,
<br /> shareholders, employees, members, and agents who are active in the management
<br /> of the entity.
<br /> 4 . 1 understand that the relationship with a County Commissioner or County employee. that
<br /> { must be disclosed is as follows:
<br /> Father, mother, son, daughter, brother, sister, uncle, aunt, first
<br /> cousin, nephew, niece, husband, wife, father4n4aw, mother4n=
<br /> law, daughter-in-law, son-in-law, brother-in-law, sister4rimlaw,
<br /> stepfather, stepmother, stepson, stepdaughter, stepbrother,
<br /> stepsister, half brother, half sister, grandparent or grandchild.
<br /> 5 . Based on my best information and belief, the statement which I have marked below is
<br /> ~' true in relation to the entity submitting this sworn statement. [Please indicate which
<br /> statement applies .]
<br /> Neither the entity submitting this sworn statement, nor any officers , directors,
<br /> executives, partners , shareholders, employees , members, or agents who are active in
<br /> management of the entity, have any relationships as defined in Section 105 . 08 , Indian
<br /> River County Code , with any County Commissioner or County employee .
<br /> The entity submitting this sworn statement, or one or more of the officers, directors ,
<br /> executives., partners , shareholders , employees , members , or agents who are active
<br /> in management of the entity have the following relationships with a County
<br /> Commissioner or County employee:
<br /> Last Revised 12/2007 00452 - 1 Wabasso Beach Pk, Restoration
<br /> FAPublic Works\Cliff SuthanikWabasso Beach ParkW construction Bid Documents\Bid Documents as of 1 -9-2008\DIv 0 AS OF 1 -
<br /> �ir 8-2008\00452 - Disclosure of Relatonships.doc
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