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AUTHORIZATION FOR RELEASE OF INFORMATION <br /> Indian River County and IRC Healthy Start Coalition Inc (Agency/Individual are <br /> in the process of negotiation of a contract for Healthy Families — IRC and the <br /> TLC Newborn Program . Indian River County is authorized to make an <br /> investigation of the Agency/Individual regarding its experience and qualifications . <br /> The Agency/Individual authorized the release of all relevant information <br /> concerning 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 Indian River County Healthy Start Coalition Inc <br /> Print name <br /> Name Employee Providin authorization Jean Anderson <br /> ' Pr' t name <br /> Signature (in blue ink) a <br /> Date 4= 2 , 05 <br /> XI <br />