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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 />or entity <br />STATE OF Florida <br />COUNTY OF Indian River <br />Name of County Commissioner <br />or employee <br />5/572021 <br />Relationship <br />(Signature) <br />(Date) <br />Sworn to (or affirmed) and subscribed before me by means of ❑ physical presence or ❑ online <br />notarization, this May 5t day of 2021 , by Shane Bar (name of <br />person making statement). t l) �2 <br />�pp Y A�HLv <br />Yta� a0 <br />(Pr <br />6f who is personally known to me <br />6f :Florida) <br />e of Notary Public) <br />Sworn Statement of Disclosure of Relationships - 00452-2 <br />FAPublic WorkAENGINEERING DIVISION PROJECTSQ022 4th Sl Culver) Replacement at901h aveXi-Adminl9ids18id,DocumentstDIV 0_2_Bidding Documents - 2020M8.doca <br />