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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 . 5054 for <br /> S. hi IArrw z5 ryices A wss © q C �6c <br /> 2 . This sworn statement is submitted by : <br /> u1os4- anc. e- Abusc C,oync i j o kG <br /> ( Name of entity submitting Statement) <br /> whose business address is : <br /> I FL 32 (76Z) <br /> and <br /> (if applicable ) <br /> its Federal Employer Identification Number ( FEIN ) <br /> is & �S — 4 Z 02 63S <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 (20 <br /> ( Pleas-}e- print name of individual signing ) <br /> and my relationshi to the entity named above is <br /> E�LL �, f4 Tl fPc,+or . <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 /> XII <br />