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Indian River Board of County Commissioners <br /> 184025 th Street <br /> Vero Beach , FL 32960 <br /> AUTHORIZATION FOR RELEASE OF INFORMATION <br /> Indian River County and )6 : 2 - 6£g (Agency/IndividualT <br /> are in the process of negotiation of a contract for <br /> Indian ' River County is authorized to make an investigation of the <br /> Agency/ Individual regarding its experience and qualifications. The <br /> Agency/ Individual authorized the release of all relevant information concerning <br /> prior services furnished , contracts and background information of the <br /> Agency/ Individual . The Agency/Individual authorizes any individual or <br /> organization that is in possession of relevant factual contract and background <br /> 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 <br /> experience . <br /> Authorization is given here by the Agency/ Individual and such employees who <br /> execute this authorization with the understanding and limitation that Indian River <br /> County will utilize the information obtained for the purposes set forth herein and <br /> that such information shall not be disclosed to third parties except as provided by <br /> law. <br /> Name Agency/Individual 'TIX Cent' �N mo 'ft ! SeivQViAl /1WA & . LkM # <br /> Print name <br /> Name Employee Providing authorization S a( CA L - • Su5 <br /> Print napW <br /> Signature ( in blue ink) <br /> Date <br /> X1 <br />