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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 OR OTHER <br /> OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement MUST be submitted with Bid , Proposal or Contract No . 2011040 <br /> for Disaster Debris Removal & Disposal Contract <br /> 2 . This sworn statement is submitted by : Omni Pinnacle , LLC <br /> ( Name of entity submitting Statement) <br /> whose business address is : <br /> 90 Glen Court , Pearl River , LA 70452 <br /> and its Federal Employer Identification Number ( FEIN ) is 30-0305755 <br /> 3 . My name is Brian Reine <br /> ( Please print name of individual signing ) <br /> and my relationship to the entity named above is Manager <br /> 4 . 1 understand that an " affiliate" as defined in Section 105 . 08 , Indian River County Code , 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 must <br /> 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 /> sisterAn-law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half <br /> brother, half sister, grandparent, or grandchild . <br /> Page 20 of 30 <br /> F :\Purchasing\Bids\2010-2011 FY (2011000)\2011040 Disaster Debris Removal and disposal Contract\2011040 Hurricane Debris <br /> Removal Bid Doc.doc <br />