Laserfiche WebLink
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 /> ✓ 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 /> ( Sig e) <br /> April 15 , 201 1 <br /> ( Date) <br /> STATE OF LOUISIANA <br /> GOUN-T-Y- - OF PARISH OF FAST BATON ROUGE <br /> The foregoing instrument was acknowledged before me this f day of VQ: <br /> 20111 by Joe K . sa leS who is personally known to me or who <br /> has produced as identification . <br /> OTARY PUBLIC <br /> SIGN : I <br /> PRINT . Daniel B . Davis , Esq . <br /> Notary Public , State at large <br /> My Commission Expires : Upon Death <br /> ( Seal ) <br /> OF LOU OFFICIAL SEAL <br /> rf' o¢ • °ate DANIEL B . DAVIS <br /> NOTARY ID NO . 86213 <br /> n • LOUISIANA BAR ROLL NO . 30141 <br /> • � � . STATE OF LOUISIANA <br /> NOTARY PUBLIC <br /> My Commission is for Life <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 />