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Bid No. 2018045/IRC-1502 <br />SWORN STATEMENT UNDER SECTION 105.08, INDIAN RIVER COUNTY CODE, ON DISCLOSURE <br />OF RELATIONSHIPS <br />THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED <br />TO ADMINISTER OATHS. <br />1. This sworn statement'MUST be submitted with Bid, Proposal or Contract No. 2018045 <br />for Gifford Area Stormwater Project <br />2. This sworn statement is submitted by: Johnson -Davis Inc:. <br />(Name of entity submitting Statement) <br />whose business address is: <br />604 Hillbrath Drive: Lantana,FL 33462 <br />and its Federal Employer. Identification Number (FEIN) is 59-1753888 <br />3. My name is Scott J. Johnson <br />(Please print name of individual signing) <br />and my relationship to the entity named above is. President <br />4. 1 understand that an "affiliate" as defined in Section 105.08, Indian River County Code, <br />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. I understand that the relationship with a County Commissioner or County employee that <br />must be disclosed as follows: <br />Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, <br />husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in- <br />law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, <br />stepsister, half-brother, half-sister, grandparent, or grandchild. <br />Page 15 of 37 <br />