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C1 <br />TSIS SQFM MUST BZ SIGM Iii 'fin V"S=CZ OF A ti 7CVMIC OR <br />. OFFICER <br />F `IC R AMCRXMD To ADMXMSTLR OATHS. <br />1. 'This sworn statement is submitted with RFP No. for <br />Cherr wood Estates Wat r E <br />2. This sworn statement is submitted by: <br />Edwin E. Upthegrove _ <br />(Name of entity submitting sworn statement) <br />whose business address is: and (If <br />3300 Bobbi. Lane <br />applicable ) its Federal Employer Identification Number <br />(FEIN) is 59-0867663 (If the entity has no FEIN, include <br />the Social. Security Number of the individual, signing this <br />sworn statement <br />3. My name is Edwin E Usatlieernve and my <br />(Print name of individual signing} <br />relationship to the entity named above is President <br />4. I understand that an affiliate" as defined in Section <br />105.08, Indian River County Code, means: <br />The term "affi.iiate" includes those officers, directors, <br />executives, partners, shareholders, employees, members, and <br />agents who are active in the management of the entity. <br />5. I understand that the relationship with a County <br />Commissioner or County employee roust be disclosed as <br />follows: <br />Father, mother, son, daughter, brother, sister, uncle, <br />aunt, first cousin, nephew, niece, husband, wife; father-in- <br />law, mother-in-law, son-in-law, brothe.L-in-law, sister-in- <br />law, stepfather, stepmother, stepson, stepdaughter, <br />stepbrother, stepsister, half brother, half sister, <br />grandparent or grandchild. <br />6. Based on information and belief, the statement which I have <br />marked below is true in relation to the entity submitting <br />00310-11 <br />