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6 . Based on information and belief, the statement , which I have marked below , is true in relation <br /> to the entity submitting this sworn statement . [ Please indicate which statement applies . ] <br /> X 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 /> 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 in <br /> management of the entity have the following relationships with a County Commissioner or <br /> County employee : <br /> Name of Affiliate Name of County Commissioner <br /> Relationship or entity or employee <br /> —T ( Signature ) <br /> 4/19/2011 <br /> ( Date ) <br /> STATE OF L C « S y4 � <br /> COU TYOF S <br /> 44 <br /> The foregoing instrument was acknowledged before me this ��day of , <br /> 2011 , by 71 '4 ��1 N , who is personally known to me or who <br /> has produced L I r v Cie L,` e � fv ,S s identification . <br /> ip <br /> NOT RY ' BLIC <br /> SIGN : 7-/ '`'2�j <br /> PRINT: <br /> Notary Public, State al lame <br /> My Commission Expires : Q ' ,5:: <br /> Darlene Y Hudson <br /> NoWypubq SLTnmwh► P&M41.A ( Seal ) <br /> #41828 COrMllflb dMW for LKe <br /> Page 21 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 />