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Bid No. 2019005/IRC-1760
<br /> SWORN STATEMENT UNDER SECTION 105008, INDIAN RIVER COUNTY CODE,
<br /> ON DISCLOSURE OF RELATIONSHIPS
<br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO
<br /> ADMINISTER OATHS.
<br /> 1. This sworn statement MUST be submitted with Bid, Proposal or Contract No. 2019005
<br /> for VICTOR HART SR. COMPLEX DRAINAGE IMPROVEMENTS (IRC-1760)
<br /> 2. This sworn statement is submitted by: Guettler Brothers Construction, LLC
<br /> (Name of entity submitting Statement)
<br /> whose business address is:
<br /> 4401 Whiteway Dairy Rd., Ft. Pierce, FL 34947
<br /> and its Federal Employer Identification Number(FEIN) is 20-3608929
<br /> 3. My name is Ben Guettler
<br /> (Please print name of individual signing)
<br /> and my relationship to the entity named above is Manager
<br /> 4. I understand that an "affiliate" as defined in Section 105.08, Indian River County 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. I understand that the relationship with a County Commissioner or County employee that must
<br /> 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-law, sister-
<br /> in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother,
<br /> half sister, grandparent, or grandchild. - -
<br /> 6. Based on information and belief, the statement, which I have marked below, is true in relation
<br /> to the entity submitting this sworn statement. [Please indicate which statement applies.]
<br /> x Neither the entity submitting this sworn statement, nor any officers, directors, executives,
<br /> partners, shareholders, employees, members, or agents who'are active in management of the
<br /> entity, have any relationships as defined in section 105.08, Indian River County Code, with any
<br /> County Commissioner or County employee.
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