Laserfiche WebLink
• <br />F-1 <br />• <br />SWORN STATEMENT UNDER SECTION 105.08, <br />INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS <br />THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR <br />OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. <br />1. This sworn statement is submitted with Bid, Bid <br />or Contract No. for <br />2. This sworn statement is submitted by: <br />SVDM WLa#t0 =piOtAW% W - <br />(name of entity submittingst�c} statement <br />SI R BUIDINGTECHN i.OGIES,ft <br />1000 OEERFIELO PAl KWAY <br />whose business address is:_ BUFF L01IR n 600&9AW <br />and (if applicable) its Federal Employer Identification Number <br />(FEIN) IS:_I -3 _�_a-76Z4f e8 (If the entity has no FEIN, include the Social <br />Security Number of the individual signing this sworn <br />statement. j <br />Noe G. Bermudez <br />1 My name is ACRIAtAnt <br />[please pfirif name a m t al signing] <br />and my relationship to the entity named above is <br />4. I understand that an "affiliate" as defined in Section 105.08, INDIAN RIVER County <br />Code, means: <br />The term "affiliate" includes those officers, directors, <br />executives, partners, shareholders, employees, members, <br />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 <br />that must be disclosed is as follows: <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, <br />sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half <br />brother, half sister, grandparent or grandchild. <br />