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SWORN STATEMENT ON DISCLOSURE OF RELATIONSHIPS AND
<br />DISCLOSURE OF FINANCIAL CONFLICT OF INTEREST
<br />THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER
<br />AUTHORIZED TO ADMINISTER OATHS.
<br />1. This sworn statement MUST be submitted with Local Jobs Grant Applications.
<br />2. This sworn statement is submitted by: Lemnature AquaFarms USA. Inc.
<br />(Name of entity submitting Statement)
<br />whose business address is:
<br />1991 741 Ave.. Suite B. Vero Beach. FL 32966
<br />3. My name is Juli-Anne W. D'Aloia
<br />(Please print full legal name of individual signing)
<br />and my relationship to the entity named above is Vice President of Human Resources
<br />4. I understand that an "affiliate" means:
<br />The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees,
<br />members, and agents who are active in the management of the entity.
<br />5. I understand that the relationship with a County Commissioner or County employee that must be
<br />disclosed as follows:
<br />Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife,
<br />father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law, stepfather,
<br />stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or
<br />grandchild.
<br />6. I understand that business relationships and other financial relationships between affiliate and a County
<br />Commissioner or County employee, as each of these terms are defined under items 4 and 5 above, must
<br />be disclosed as part of this sworn statement.
<br />7. Based on information and belief, the Disclosure of Relationships statement, which I have marked below,
<br />is true in relation 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 />partners, shareholders, employees, members, or agents who are active in management of the entity, have
<br />an\ relationshil)s as defined under item number 5 above, with any County Commissioner or County
<br />employee.
<br />ATTACHMENT 1 263
<br />Local Jobs Grant Applicant Sworn Statement on Disclosure of Relationships Page 1 of 3
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