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2017-027F
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2017-027F
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Last modified
10/6/2017 11:00:52 AM
Creation date
3/21/2017 2:21:42 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
02/21/2017
Control Number
2017-027F
Agenda Item Number
12.F.1
Entity Name
Community Asphalt Corporation
Subject
Round Island Park Pavement Resurfacing
Contract & Specifications
Area
Round Island Park
Project Number
1619
Bid Number
201717
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The entity submitting this sworn statement, or one or more of the officers, directors, executives, <br /> partners, shareholders, employees, members, or agents, who are active in management of the entity <br /> have the following relationships with a County Commissioner or County employee: <br /> Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> i <br /> qigature) <br /> f �� <br /> (Date) <br /> STATE OF FL <br /> COUNTY OF Indian River <br /> The foregoing instrument was acknowledged before me this day of J 4Vr a ,2017, by <br /> Manuel Aguiar ,who is personally known to me or who has produced <br /> as identification. <br /> NOTARY PUBLIC / <br /> SIGN: <br /> PRINT: Jennifer Bickford <br /> Notary Public, State at large <br /> My Commission Expires: 3/23/2018 <br /> (Seal) �r� Notary Public Stele of Florida <br /> Jennifer Bickford <br /> My Commission FF 100540 <br /> R Expires 03123/2018 <br /> 00452-2 <br /> FAI?ublic Works\ENGINEERING DIVISION PROJECTS\1619 Round Island Facility Paving\1-Adm1n\bid documentsWaster Contract <br /> Documents\00452 Disclosure of Relationships.doc <br />
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