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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 <br />or entity <br />STATE OF Florida <br />COUNTY OF Indian River <br />Name of County Commissioner <br />or employee <br />July 12, 2417 <br />(Date) <br />Relationship <br />The foregoing instrument was acknowledged before me this 12th day of July , 2017 , by <br />Matthew S. Eisen who is personally known to me or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIGN: <br />PRINT: 1,yell 5w , Y! <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) <br />LYM Q SWIFT <br />**:= <br />4:WWMbet12.202$ <br />'Fof P Bay W T11 u Budget Wary SWIM <br />00452-2 <br />F:\PubficWorRskENGINEERING DIVISION PROJECTSM15 Go -Line taus Tum -Off (90th Avenue)11-Admin\Bid DocumentsWaster Contract <br />Dccuments\00452 Disclosure of Relationships.doc <br />