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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 . 6067 for Healthy Families — <br /> IRC and the TLC Newborn Program <br /> 2 . This sworn statement is submitted by: Jean Anderson <br /> Indian River County Healthy Start Coalition Inc . <br /> (Name of entity submitting Statement) <br /> whose business address is : <br /> 1603 10"' Avenue Vero Beach FL 32960 and <br /> (if applicable ) <br /> its Federal Employer Identification Number ( FEIN ) is 6503 63 222 <br /> ( If the entity has no FEIN , include the Social Security Number of the individual <br /> signing this sworn statement <br /> 3 . My name is Jean Anderson <br /> ( Please print name of individual signing ) <br /> and my relationship to the entity named above is Board President <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 /> 5 . 1 understand that the relationship with a County Commissioner or County <br /> employee that must be disclosed as follows : <br /> Father, mother, son , daughter, brother, sister, uncle , aunt , first cousin , <br /> nephew, niece , husband , wife , father- in- law , mother- in -law, daughter- <br /> XII <br />