|
SWORN STATEMENT UNDER SECTION 10508
<br />INDIAN RIVER COUNT CODE ON DISCLOSURE OF RELATIONSHIPS
<br />This form must be signed in the presence of a notary public or other officer authorized to administer
<br />oaths.
<br />1. This swom statement is submitted with Bid, Proposal or Contract No.
<br />for Audit Services.
<br />2. This swam statement is submitted by: Harris, Cotherman & Associates, CPA's Chartered.
<br />Whose business address is:
<br />5070 North Highway AIA, Suite 250, Vero Beach, FL 32963
<br />and (if applicable) its Federal Identification Number (FEIN) is:
<br />65-0689902
<br />(If the entity has no FEIN, include the Social Security Number of the individual signing this swom
<br />statement ,)
<br />3. My name is Robert R. Harris and my relationship to the entity named above is Managing Director.
<br />4. 1 understand that an "affiliate" as defined in Section 105.08, Indian River County Code, means:
<br />The term "affiliate' includes those officers, directors, caremives, partners, shareholders,
<br />employees, members, and agents who are active in the management of the entity.
<br />5. 1 understand that the relationship with a County Commissioner or County employee must be
<br />disclosed as follows:
<br />Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband,
<br />wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law,
<br />stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister,
<br />grandparent or grandchild.
<br />6. Based on information and belief, the statement which I have marked below is Ime in relation to the
<br />entity submitting this sworn statement. (Please indicate which statement applies.)
<br />X Neither the entity submitting this swom statement, nor any officers, directors, executives,
<br />partners, shareholders, employees, members, or agents who are active in management of the
<br />entity, have any relationships as defined in Section 105.08, Indian River County Code, with any
<br />County Commissioner or County employee.
<br />
|