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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 <br /> OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement is submitted with RFP No . 4046 for <br /> 2 . This sworn statemen is submitted by : <br /> �o � a na � � �h a ✓1 tN� � I-��u.Q.� Gh � T� <br /> ( Name of entity submitting Statement ) <br /> whose business address is : <br /> _ 1 o00 3Com .5triefi , VefV &a 5-2q& 0 and <br /> ( if applicable ) <br /> its Federal Employer Ide��jjtification Number ( FEIN ) <br /> ( If the entity has no FEIN , include the Social Security Number of the individual <br /> signing this sworn statement <br /> tjliq ) <br /> 3 . My name is J— <br /> ( Please print name of individual signing ) <br /> and my relationship to the entity named above is <br /> 4 . 1 understand that an " affiliate" as defined in Section 105 . 08 , Indian River <br /> County Code , means : <br /> The term " affiliate" includes those officers , directors , executives , partners , <br /> shareholders , employees , members , and agents who are active in the <br /> management of the entity . <br /> XII <br />