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AUTHORIZATION FOR RELEASE OF INFORMATION <br /> Indian River County and (Agency/Individual are in <br /> the process of negotiation of a contract for <br /> Indian River County is authorized to make an investigation of the Agency/Individual <br /> regarding its experience and qualifications. The Agency/Individual authorized the <br /> release of all relevant information concerning prior services furnished, contracts and <br /> background information of the Agency/Individual. The Agency/Individual authorizes any <br /> individual or organization that is in possession of relevant factual contract and <br /> background information, to release such data to Indian River County in response of the <br /> County's request. <br /> When an individual employee of the Agency signs Authorization for Release of <br /> Information, such individual authorizes the County to obtain relevant background <br /> information concerning such employee's criminal record, if any, and such other <br /> information that may be relevant to employee's good character and work experience. <br /> Authorization is given here by the Agency/Individual and such employees who execute <br /> this authorization with the understanding and limitation that Indian River County will <br /> utilize the information obtained for the purposes set forth herein and that such <br /> information shall not be disclosed to third parties except as provided by law. <br /> Name Agency/Individual <br /> Print name <br /> Name Employee Providing authorization <br /> Print name <br /> Signature (in blue ink) <br /> Date <br /> XII <br /> 129 <br />