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SWORN STATEMENICER SECTION 105 .08, INDW RIVER COUNTY <br /> CODE , ON DISCLOSURE OF RELATIONSHIPS <br /> * THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER <br /> OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement is submitted with Bid, Proposal or Contract No . �=5 for <br /> IRrdmi TBuild ! Rg <br /> 2 . This sworn statement is submitted by: Robert E . Fields <br /> Mid - State Mechanical of Vero Beach , Inc . <br /> (Name of entity submitting Statement) <br /> whose business address is : <br /> 3825 71st . Street - Vero Beach , FT , 12g67 and <br /> (if applicable) its Federal Employer Identification Number (FEIN) is 5-g _ 1 R 3 7 4 7 R (If <br /> the entity has no FEIN, include the Social Security Number of the individual signing this <br /> sworn statement ) <br /> • 3 . MY name is <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above is <br /> 4 . I understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code, <br /> means : <br /> The term "affiliate" includes those officers, directors, executives, partners, shareholders, <br /> employees , members, and agents who are active in the management of the entity. <br /> 5 . I understand that the relationship with a County Commissioner or County employee that must <br /> be disclosed as follows : <br /> Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, <br /> husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, <br /> sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half <br /> brother, half sister, grandparent, or grandchild. <br /> Page 32 of 48 <br />