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X The entity submitting this sworn statement, or one or more of the officers, directors, executives, <br /> partners, shareholders, employees, members, or agents, who are active in management of the entity <br /> have the . following relationships with a County Commissioner or County employee : <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> Phil Barth Sandy Wright Cousin <br /> (Signature) <br /> November 21 , 2012 <br /> (Date) <br /> STATE OF Florida <br /> COUNTY OF Indian River <br /> The foregoing instrument was acknowledged before me this 21stday of November , 20 121 by <br /> Phil earth , who is personally known to me or who has produced <br /> as identification. <br /> NOTARY PUBLIC <br /> SIGN: <br /> PRINT: iZI AIZZ i,, s✓ <br /> Notary Public, State at large <br /> My Commission Expires : <br /> (Seal) <br /> oil <br /> MARIONKTWEK <br /> WCOMMISS(ONi EE189989EXPIRES: July 21 , 2016 <br /> 9ortded Thnt Nalety Pu6gc Undelwtlte�s <br /> 00452-2 <br /> R1Public Works\ENGINEERING DIVISION PROJECTSN 126 - RFP South Co Park Multi Purpose FletdsWdmimlbid documentsTontract <br />