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SECTION 00452 <br /> SWORN STATEMENT UNDER SECTION 105.08,INDIAN RIVER COUNTY CODE, <br /> ON DISCLOSURE OF RELATIONSHIPS <br /> T14IS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER <br /> AUTHORIZED TO ADMINISTER OATHS. <br /> 1. This sworn statement MUST be submitted with Bid,Proposal or Contract No.2017017 <br /> for ROUND ISLAND RIVERSIDE PARK PAVEMENT RESURFACING <br /> 2. This sworn statement is submitted by: Community Asphalt,Corp. <br /> (Name of entity submitting Statement) <br /> whose business address is: <br /> 2975 Industrial Blvd.Vero Beach,FL 32967 <br /> 3. My name is Manuel Aguiar <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above is Vice President <br /> 4. I 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, employees, <br /> members, and agents who are active in the management of the entity. <br /> 5. I understand that the relationship with a County Commissioner or County employee that must be <br /> disclosed as follows: <br /> Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, <br /> father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law, stepfather, <br /> stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or <br /> grandchild. <br /> 6. Based on information and belief, the statement, which I have marked below, is true in relation to the <br /> entity submitting this sworn statement. [Please indicate which statement applies.) <br /> x Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, <br /> shareholders, employees, members, or agents who are active in management of the entity, have any <br /> relationships as defined in section 105.08,Indian River County Code, with any County Commissioner <br /> or County employee. <br /> 00452-1 <br /> FAPublic Works\ENGINEERING DIVISION PROJECTSM19 Round Island Facility Pavingl1-Adminlbid documents%Master Contract <br /> Documents100452 Disclosure of Relationships.doc <br />