Laserfiche WebLink
Bid No. 2020048/IRC-1816 <br />The entity submitting this sworn statement, or one or more of the officers, directors, <br />executives, partners, shareholders, employees, members, or agents, who are active in <br />management of the entity have the following relationships with a County Commissioner or <br />County employee: <br />Name of Affiliate <br />or entity <br />STATE OF F I <br />Name of County Commissioner <br />or employee <br />COUNTY OF�- <br />Relationship <br />(Signature) <br />(Date) <br />Sworn to (or affirmed) and subscribed before me by means'5Rf M" physical presence or ❑ online <br />notarization, this 110' day of 21 L� by PG.VU►.�.Dn0 �VGh�' Z (name f per n making <br />statement). , / ,� <br />14 (1 *d'&t WZ I %T" / n !:�r <br />(Signat re of Nory Public - StatffofFlorida <br />(Print, Type, or Stamp mmissioned Name of Notary Public) <br />%; KELLY MINOTT <br />;= Notary Public -State of Florida <br />�• •' Commission M GG 967561 <br />on <br />who is personally known to me or ❑ who has produced °,au, My CommissJU y 0412024 Aires <br />as identification. <br />Page 19 of 39 <br />