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The entity submitting this sworn statement, or one or more of the officerS,. directors, exeetitives, <br />partners, -shareholders, employees, members; or agents, who are active in management of the entity <br />have the following relationships with a County Cortunissioner or .County employee; <br />Nanie:o.f Affiliate <br />Name of COUnty COMM N6Oper Relationship <br />or entity or eniplOyee <br />STATE OF Florida <br />7 <br />05.15.19 <br />(Date) <br />COUNTY OF Indian River <br />The fOregOing instrument was acknowledged before me this 15th day of May , 2019 'by <br />who is personally known to me or who has produced <br />as identification.• <br />SIGN: <br />1\1LsOl'ARY T313LIC <br />ft% <br />PRINT: Deborah. West <br />00452-2 <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) rec.7,,is;..z.:Aca, v•,,N <br />- s <br />6 -lb ii:e7,07 <br />MY COMMISSION Al FE904:r7 <br />EXPiRES:0Gtob 03,2019 I <br />F:\Publio WorkEil0IN'EERING DIVISION PROJECTS11628-85th Strpgt. 0601 Aveio 101st Ave_ Ro,adway Imprpvernents\ t-Adiniri\BicMf3id <br />DocOmpAtsaasier Contract POcujfierits100452 DiclOstgp of RelOtionthip-s.doc <br />