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SECTION 00452
<br /> DISCLOSURE OF RELATIONSHIPS
<br /> 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 Contract No . for the Floating
<br /> Mat System for the Spoonbill Marsh Wetland Facility .
<br /> 1 . This sworn statement MUST BE submitted by :
<br /> whose business address is : ( Name of entity submitting sworn statement )
<br /> ( if applicable ) its Federal Employer Identification Number ( FEIN ) is and
<br /> 2 . My name is
<br /> ( Please print name of individual signing )
<br /> and my relationship to the entity named above is
<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, father-in -law, mother-in -
<br /> law, daughter-in -law, son -in -law, brother-in -law, sister-in -law,
<br /> stepfather, stepmother, stepson, stepdaughter, stepbrother,
<br /> stepsister, half brother, half sister, grandparent or grandchild.
<br /> 5 . 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 /> Neither the entity submitting this sworn statement , nor any officers , directors ,
<br /> executives , partners , shareholders , employees , members , or agents who are active
<br /> in management of the entity , have any relationships as defined in Section 105 . 08 ,
<br /> Indian 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 /> 00452 - 1
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