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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 OR
<br /> OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS .
<br /> 1 . This sworn statement is submitted with RFP No. 2006061 for Children 's Services
<br /> Advisory Committee Grant Funds for Children 's Programs — Childcare Access
<br /> 2 . This sworn statement is submitted by : EARLY LEARNING COALITION OF
<br /> INDIAN RIVER, MARTIN AND OKEECHOBEE COUNTIES INC
<br /> (Name of entity submitting Statement)
<br /> whose business address is : 2415 South 29th Street and
<br /> (if applicable)
<br /> its Federal Employer Identification Number ( FEIN) is 65- 1035652
<br /> ( If the entity has no FEIN , include the Social Security Number of the individual signing
<br /> this sworn statement
<br /> 3 . My name is OLAN FAULK
<br /> ( Please print name of individual signing)
<br /> and my relationship to the entity named above is EXECUTIVE DIRECTOR
<br /> 4 . 1 understand that an "affiliate" as defined in Section 105 . 08 , Indian River County
<br /> Code, 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
<br /> 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 /> in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
<br /> stepson , stepdaughter, stepbrother, stepsister, half brother, half sister,
<br /> grandparent, or grandchild .
<br /> 6 . Based on information and belief, the statement, which I have marked below is true in
<br /> relation to the entity submitting this sworn statement. [Please indicate which statement
<br /> applies . ]
<br /> X Neither the entity submitting this sworn statement, nor any officers , directors ,
<br /> executives , partners , shareholders, employees , members, or agents who are
<br /> active in management of the entity , have any relationships as defined in section
<br /> XIII
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