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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 /> xxx 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 /> Not Applicable <br /> r' <br /> (Signature) <br /> April 15 , 2011 <br /> ( Date) <br /> STATE OF Louisiana <br /> COUNTY OF Jefferson <br /> The foregoing instrument was acknowledged before me this 1 5thday of April <br /> 2011 , by Arcenious F . Armond , Jr , who is personally known to me or who <br /> has produced as identification . <br /> NOT RY P BLIC <br /> SIGN : <br /> PRINT : <br /> Notaryublic, State at large <br /> My Commissio . Expires : <br /> p hCRpENICKE.R <br /> a6rUr `� QUBLIC <br /> ti <br /> It) NEJ �h6ER , 39615 <br /> N1 0. <br /> BAR( SHLA <br /> JEFF ` RSo : ' ,iIEC , F © RUFB <br /> t � of eti'� [�� tSct [i[� <br /> Page 21 of 30 <br /> FAPurchasing\Bids\2010-2011 FY (2011000)12011040 Disaster Debris Removal and disposal Contract12011040 Hurricane Debris <br /> Removal Bid Doc. doc <br />