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Cultural Council of Indian River County; After School Arts Program <br /> Children' s Services Advisory Committee 2004 <br /> Indian River Board of County Commissioners <br /> 1840 25th Street <br /> Vero Beach , FL 32960 <br /> AUTHORIZATION FOR RELEASE OF INFORMATION <br /> Indian River County and Cultural Council of Indian River County are in the process <br /> of negotiation of a contract for After School Arts Program . <br /> Indian River County is authorized to make an investigation of the Agency/Individual <br /> regarding its experience and qualifications . The Agency/ Individual authorized the <br /> release of all relevant information concerning prior services furnished , contracts and <br /> background information of the Agency/Individual . The Agency/Individual authorizes any <br /> individual or organization that is in possession of relevant factual contract and <br /> background 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 experience . <br /> Authorization is given here by the Agency/ Individual and such employees who execute <br /> this authorization with the understanding and limitation that Indian River County will <br /> utilize the information obtained for the purposes set forth herein and that such <br /> information shall not be disclosed to third parties except as provided by law. <br /> Name Agency/Individual Cultural Council of Indian River County <br /> Name Employee Providing authorization Mary Jayne Kelly <br /> Signature ( in blue ink) W41 <br /> ' <br /> Date : May 19 , 2004 <br /> t y <br /> A r K7 <br /> 1 <br /> � %' ] aF `=t4a I ?.4£� �. t �* -s4.•" . . . , s ' ?-; . � rr .f n;�` ��' 4.*4-'.'•2#,� i , ii ( .''-''= <br />