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SWORN STATEMENT UNDER SECTION 105.08,
<br />INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS
<br />THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR
<br />OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.
<br />1. This sworn statement is submitted with RFP No. 2017044 for
<br />2. This sworn statement is submitted by:
<br />(Name of entity submitting Statement)
<br />whose business address is:
<br />and
<br />3. My name is
<br />(if applicable)
<br />(Please print name of individual signing)
<br />and my relationship to the entity named above is
<br />4. 1 understand that an "affiliate" as defined in Section 105.08, Indian River County
<br />Code, means:
<br />The term "affiliate" includes those officers, directors, executives, partners, shareholders,
<br />employees, members, and agents who are active in the management of the entity.
<br />5. 1 understand that the relationship with a County Commissioner or County employee
<br />that must be disclosed as follows:
<br />Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin,
<br />nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-
<br />in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
<br />stepson, stepdaughter, stepbrother, stepsister, half brother, half sister,
<br />grandparent, or grandchild.
<br />6 Based on information and belief, the statement, which I have marked below is true in
<br />relation to the entity submitting this sworn statement. [Please indicate which statement
<br />applies.]
<br />Neither the entity submitting this sworn statement, nor any officers, directors,
<br />executives, partners, shareholders, employees, members, or agents who are
<br />active in management of the entity, have any relationships as defined in section
<br />XII
<br />P70
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