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RFP 2019036 2017-18 CDBG Administration Services <br />entity, have any relationships as defined in section 105.08, Indian River County Code, with any <br />County Commissioner or County employee. <br />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 <br />entity have the following relationships with a County Commissioner or County employee: <br />Name of Affiliate Name of County Commissioner Relationship <br />or entity or employee <br />STATE OF <br />COUNTY OF <br />(Signature) <br />(Date) <br />The foregoing instrument was acknowledged before me this day of , 20 , by <br />, who is personally known to me or who has produced <br />as identification. <br />SIGN: <br />NOTARY PUBLIC <br />PRINT: <br />Page 18 of 20 <br />Notary Public, State at Targe <br />My Commission Expires: <br />(Seal) <br />