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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 with a County Commissioner or County employee: <br />Name of Affiliate <br />Name of County Commissioner Relationship <br />or entity or employee <br />STATE OF Florida <br />COUNTY OF Brevard <br />(Signature) <br />t(Date) <br />The foregoing instrument was acknowledged before me this 1st day of March , 20 19 , by <br />Erik Costin , who is personally known to me or who has produced <br />as identification. <br />SIGN: <br />NOT, Y PUBLIC <br />Notary P . blic, State at large <br />My Commission Expires: <br />(Seal) <br />.•o<d:"'i% .,; SHELLEY D. SUTHERLAND <br />V% MY COMMISSION # FF 224378 <br />,.� EXPIRES: June 8, 2019 <br />off,,,, Bonded Thru Notary Public Underwriters <br />00452-2 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1728 IRC Courthouse Renovations Project\1-Admin\Bid Documents\Master Contract <br />Documents\00452 Disclosure of Relationships.doc <br />