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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 Relationship <br /> or entity or employee <br /> (Signature) <br /> STATE OF FI- orida (Date) <br /> Cnl_1NTY OF Dade <br /> The foregoing instrument was acknowledged before me this 21 day of _Jan . _, 20_ l , by <br /> Charles H . Floyd who is personally known to mc; or who has <br /> produced Known as identification . <br /> NOTARY PUBLIC <br /> SIGN : e z"1 < <br /> el <br /> PRINT : JoAnn Mora 1 P a ±.Qgj,> e <br /> State of Florida at Large <br /> My Commission Expires : <br /> ( Seal ) <br /> JOANN MORALES SASTOQUE <br /> MY COMMISSION # DD 987123 <br /> EXPIRES: August 31 , 2014 <br /> ttf tyQ Bonded Thru Notary Public Undenwite <br /> F'\Purchasing\Bids\2010-201 1 FY (2011000)\2011025 Vero Beach Shorts Village Sports Lighting System\Bid Docs VBSV Lighting revised Sectio <br /> I .doc <br />