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xxxNeither the entity submitting this sworn statement, nor any officers, directors , executives <br />--partners, shareholders, employees, members, or agents who are active in management of' <br />the entity, have any r~ionships as defined in Section I 05.08, Indian Rive r County <br />Code, with any County Commissioners or Cowlty employee. <br />__ The entity submitting this sworn statement, or one or more of the o ffi cers, directors, <br />executives, partners, shareholders, employees, members or agents who are active in <br />management of the entity have th e following relati onships with a County Commissioner <br />or County employee. <br />Name of Affiliate <br />Or Entity <br />State of Florida <br />County of Polk <br />Name of County <br />· Commissioners <br />R elationship <br />~cQl (SignaMe) <br />9/6/00 <br />(Date) <br />The foregoing instrument was ackno ay of Se p tembe r ,2000, by <br />Jason T . Cha mbers , who i_,,_....,...-"--.....;......;.;....:..C-'-"" or has produced _____ _ <br />(SEAL) <br />END O F SECTION <br />003 10-12 <br />GAY •:ELL 0. STOUTZ <br />Noinry Pu~tic. Sl ~l t o f Florida <br />Mv cu mn , expires Jan . 9, 2002 r;,.,,.,. No. CC67A82~