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Data Flow Systems
<br /> ( Company Name )
<br /> SECTION 00452
<br /> SWORN STATEMENT UNDER SECTION 105 . 08 , INDIAN RIVER COUNTY CODE , ON
<br /> DISCLOSURE OF RELATIONSHIPS
<br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br /> OFFICER AUTHORIZED TO ADMINISTER OATHS ,
<br /> 1 . This sworn statement MUST be submitted with Bid , Proposal or Contract No 2011032
<br /> for Reuse Distribution Automation System
<br /> 2 . This sworn statement is submitted by : Data Flow Systems , Inc .
<br /> ( Name of entity submitting Statement)
<br /> whose business address is :
<br /> 605 N . John Rodes Blvd ,
<br /> Thomas F . Smaidris
<br /> 3 . My name is
<br /> ( Please print name of individual signing )
<br /> and my relationship to the entity named above is
<br /> President
<br /> 4 . 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 , shareholders ,
<br /> employees , members , and agents who are active in the management of the entity .
<br /> 5 . 1 understand that the relationship with a County Commissioner or County employee that
<br /> must be disclosed as follows :
<br /> Father , mother , son , daughter , brother, sister, uncle , aunt , first cousin , nephew , niece ,
<br /> husband , wife , father- in - law, mother- in - law, daughter- in - law, son - in - law, brother- in - law ,
<br /> sister- in - law , stepfather, stepmother , stepson , stepdaughter, stepbrother , stepsister, half
<br /> brother , half sister, grandparent , or grandchild .
<br /> 6 . Based on information and belief, the statement , which I have marked below , is true in
<br /> relation to the entity submitting this sworn statement . [ Please indicate which statement
<br /> applies . ]
<br /> X
<br /> Neither the entity submitting this sworn statement , nor any officers , directors , executives ,
<br /> partners , shareholders , employees , members , or agents who are active in management of
<br /> the entity , have any relationships as defined in section 105 . 08 , Indian River County Code ,
<br /> with any County Commissioner or County employee .
<br /> I
<br /> 00452- 1
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