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<br />'--.-"SWORN STATEMENT UNDER SECTION ;105.08,
<br />INDIAN RIVER COUNTY.CODE,.ON DISCLOSURE OF RELATIONSHIPS'
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<br />"w THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY.PUBLIC OR OTHER'
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<br />OFFICER AUTHORIZED TO ADMINISTER OATHS,
<br />1. This:sworn statement is submitted with Bid., Proposal -
<br />or Contract No. "6080.. _.......--for 96-FOI-2 Project
<br />2" This sworn:stateihent is submitted by:
<br />.::tet Alicomm ntworks Inc.
<br />> +;; [name of entity. submitting sworn statement] -
<br />whose,business-address is: 1315 0SE Flora Avenue, Hobe Sound F1. 33455
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<br />' and(if applicable) its Federal Employer Identification Number
<br />...
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<br />(FEIN). IS:9— 2865539 (If the entity has no FEIN, include the Social Security`'
<br />Number -individual s
<br />.
<br />of the t— iii
<br />signing sworn statement. }
<br />_ '+3: 'My -name is,.Joseoh- O`. Xi�linski
<br />' 1[please-print name of individual signing]
<br />sand my:relationship to the entity named above is President
<br />4. 1 understand'thauan "affiliate" as defined in Section 105.08, INDIAN RIVER -COUNTY Code,..
<br />means:
<br />The term "affiliate" includes those ofiicers,'dire'ctors,
<br />executives, partners, shareholders, employees, members,
<br />y �,
<br />and agents who are active in the management of the entity.
<br />5. I understand that the relationship wit}i a County Commissioner or County employee'that must
<br />be.disclosed is as follows::, w :*
<br />Father, mother, son,+ daughter, brother, sister, uncle, aunt, first cousin, nephew, niece,
<br />husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-
<br />3
<br />in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half
<br />sister, grandparent or grandchild. F ' f • ' • '.
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<br />77
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