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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 /> Ncje--p lid v►soeA Coi lmiLet Funds of <br /> 2 . This sworn statemen Js submitted by: <br /> ( Name of entity submitting Statement ) <br /> whose business address is : <br /> 100O 3Co44 5-)I-rCef , VerV &a�ah , FZ 3-2 Zq& O and <br /> ( if applicable) <br /> its Federal Employer Ide tification Number ( FEIN ) <br /> is Ga � <br /> ( If the entity has no FEIN , include the Social Security Number of the individual <br /> signing this sworn statement <br /> tj liq ) <br /> 3 . My name is .,, - <br /> f f i �i6si <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 />