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Bid No. 2019031/IRC-1802 <br />SWORN STATEMENT UNDER SECTION 105.08, INDIAN RIVER COUNTY CODE 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. 2019031 <br />for IRC NORTH COUNTY RO PLANT ROOF REPLACEMENT (IRC -1802) <br />2. This sworn statement is submitted by: <br />Vero Beach Roofing Inc <br />(Name of entity submitting Statement) <br />whose business address is: <br />835 10th Ave SW Vero Beach, FL 32962 <br />and its Federal Employer Identification Number (FEIN) is 5 - 0 8 6 5 2 88 <br />3. K4yname is Dale Bischof f <br />(Please print name of individual signing) <br />and rny relationship to the entity named above is Estimator <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. | 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, nnothepin-|aw4 daughter-in-law, son-in-law, bnothepin-|aw\ sister- <br />in-law, <br />istepin-|am4 stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half-brother, <br />half-sister, grandparent, or grandchild. <br />6. Based on information and belief, the statement, which | 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 />Page 19 of 41 <br />