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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 1 (diun ? tyCrAenW, "41 /6s0 . � el;�A (Agency/ Individual <br /> are in the process of negotiation of a contract for <br /> I a6.�� ff <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 jhe, CenW :CL( mohloa l sehayiivctl dedflA @ z em <br /> Print name <br /> Name Employee Providing authorization J� Sus i <br /> !7 Print n �' <br /> Signature ( in blue ink) <br /> s <br /> Date 5 � oA 7 - o3 <br /> XI <br />