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2018-078A
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Last modified
12/29/2020 1:35:27 PM
Creation date
5/24/2018 10:35:12 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/01/2018
Control Number
2018-078A
Agenda Item Number
8.J.
Entity Name
Johnson Davis, Inc.
Subject
Award of project for Gifford Area Stormwater project improvements
Area
Gifford between 41st and 43rd Street; 28th Avenue to R.R. Tracks
Project Number
1502
Bid Number
20188045
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Bid No. 2018045/IRC-1502 <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 />X Neither the entity submitting this sworn statement, nor any officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active in <br />management of the entity, have any relationships as defined in section 105.08, Indian <br />River County Code, with any County Commissioner or County employee. <br />The entity submitting this sworn statement, or one or more of the officers, directors, <br />executives, partners, shareholders, employees, members, or agents, who are active in <br />management of the entity have the following relationships with a County Commissioner <br />or County employee: <br />Name of Affiliate Name of County Commissioner Relationship <br />or entity or employee <br />N/A <br />(Signature) <br />(.Date) <br />STATE OF F7I0Ct da <br />COUNTY OF PAM &_DZI A . <br />The foregoing instrument was acknowledged before_ me this 29 day of 0qACk 20 <br />by SCO.,�t��1YLS0n• ,who is personallvlcnown to me or <br />who has produced as <br />identification. <br />NOTARY PUBLIC <br />?off; ?�avc YAMILM HOFFMAN <br />* * MY COMMISSION# GG 021599 SIGN: �-�, �^.,�<< <br />EXPRES:August1S,2020 <br />a_ <br />��OFF�°� ����etNotarySe�vloes <br />PRINT: YYl t�� <br />Notary Public, State at large <br />My Commission Expires: 'S h rl2ozo <br />
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