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AUTHORIZATION FOR RELEASE OF INFORMATION <br />Indian River County and (Agency/Individual are in <br />the process of negotiation of a contract for <br />Indian River County is authorized to make an investigation of the Agency/Individual <br />regarding its experience and qualifications. The Agency/Individual authorized the <br />release of all relevant information concerning prior services furnished, contracts and <br />background information of the Agency/Individual. The Agency/Individual authorizes any <br />individual or organization that is in possession of relevant factual contract and <br />background information, to release such data to Indian River County in response of the <br />County's request. <br />When an individual employee of the Agency signs Authorization for Release of <br />Information, such individual authorizes the County to obtain relevant background <br />information concerning such employee's criminal record, if any, and such other <br />information that may be relevant to employee's good character and work experience. <br />Authorization is given here by the Agency/Individual and such employees who execute <br />this authorization with the understanding and limitation that Indian River County will <br />utilize the information obtained for the purposes set forth herein and that such <br />information shall not be disclosed to third parties except as provided by law. <br />Name Agency/Individual <br />Print name <br />Name Employee Providing authorization <br />Signature (in blue ink) <br />Date <br />Print name <br />XIII <br />140 <br />