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SWORN STATEMENT UNDER SECTION 105.08, INDIAN RIVER COUNTY CODE , ON
<br /> 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 . 2011025
<br /> for - _ Vero Beach Sports Village Sport Li hting Systems
<br /> 2 . This sworn statement is submitted by:
<br /> Electrical Contracting Service , Inc
<br /> (blame of entity submitting Statement)
<br /> whose business address is :
<br /> 2375 West 77th Street , Hialeah , FL 33016
<br /> And its Federal Employer Identification Number (FEIN) is 59 - 2552102
<br /> 3 . Mynalne is Charles H . Floyd
<br /> (Please print name of individual signing)
<br /> and my relationship to the entity named above is President
<br /> 4 . 1 understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code,
<br /> means : The term "affiliate" includes those officers, directors, executives, partners,
<br /> shareholders , employees, members, and agents who are active in the management of the
<br /> entity.
<br /> 5 . I 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 /> 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 /> XX Neither the entity submitting this sworn statement, nor any offict°rs, directors,
<br /> executives, partners, shareholders, employees, members, or agents who are active in
<br /> management of the entity, have any relationships as defined in section 105 . 08 , Indian River
<br /> County Code, with any County Commissioner or County employee .
<br /> 1.1 :\Purchasing\Bids\2010-201 1 FY (2011 000)\2011025 Vero Beach Sports Village Sports Lighting System\Bid Docs VBSV Lighting revised Sectioln4
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