Laserfiche WebLink
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 witha County Commissioner or County employee: <br />Name of Affiliate Name of County Commissioner <br />or entity or employee <br />STATE OF Florida <br />COUNTY OF Indian River <br />Relationship <br />(Signature) <br />08.08.18 <br />(Date) <br />The foregoing instrument was acknowledged before me this 8th day ofA_ �iql Ist , 2018 , by <br />Timothy Rose who is personally known to me or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIGN: <br />PRINT: '@ebbrah West <br />Notary Public, State at large <br />My Commission Expires: <br />SPPY Pj <br />(Seal) EB <br />ORAH WEST, <br />MY COMMSSION # FF904578 <br />I FXPIRFS: October 03, 201.9 <br />.00452-2. <br />F;\Public Works\ENGINEERING DIVISION PROJECTS\1719 Atlantic Blvd Parkng Area Project\1-Admin\Bid Documents\Master Contract <br />Documents\00452 Disclosure of Relationships,doc <br />