Laserfiche WebLink
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 . <br /> Bid # 2011040 for Indian River County Disaster Removal & Disposal Contract <br /> 2 . This sworn statement is submitted by : Unified Recovery Group , LLC <br /> ( Name of entity submitting Statement) <br /> whose business address is : <br /> 631 Main Street , Baton Rouge , Louisiana 70801 <br /> and its Federal Employer Identification Number ( FEIN ) is 20- 3453095 <br /> 3 . My name is Joel K . Scales <br /> ( Please print name of individual signing ) <br /> and my relationship to the entity named above is Chief Financial Officer of Unified <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 /> sister- in- 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 />