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<br /> SWORN STATEMEimT UNDER SECTION 105 . 08 , IN1► IAN RIVER COUNTY
<br /> CODE , ON DISCLOSURE OF RELATIONSHIPS
<br /> THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
<br /> OFFICER AUTHORIZED TO ADMINISTER OATHS ,
<br /> 1 . This sworn statement is submitted with Bid, Proposal or Contract No . 6015 for
<br /> DOUGLAS CAFETERIA BLDG .
<br /> 2 . This sworn statement is submitted by:
<br /> HVAC MECHANICAL , INC .
<br /> (Name of entity submitting Statement)
<br /> whose business address is :
<br /> 5425 NW 24th STREET , SUITE 208 , MARGATE , FL 33063
<br /> and
<br /> (if applicable) its Federal Employer Identification Number (FEIN) is 03 - 0489407 ( If
<br /> the entity has no FEIN, include the Social Security Number of the individual signing this
<br /> sworn statement )
<br /> 3 . My name is FRANK 0 MONTI , JR .
<br /> (Please print name of individual signing)
<br /> and my relationship to the entity named above is PRESIDENT
<br /> 4 . I understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code ,
<br /> 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 that must
<br /> be disclosed as follows :
<br /> Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew , niece ,
<br /> husband, wife, father-in-law, mother-in- law, daughter-in-law, son- in- law, brother- in- law ,
<br /> sister-in- law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half
<br /> brother, half sister, grandparent, or grandchild .
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