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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 /> Safe FamiliesNalued Visits <br /> 2 . This sworn statement is submitted by : <br /> Exchange Club CASTLE <br /> ( Name of entity submitting Statement) <br /> whose business address is : <br /> _P . O . Box 12908 , Fort Pierce , FL 34979 and <br /> ( if applicable) <br /> its Federal Employer Identification Number ( FEIN ) is <br /> 59 -2094472 <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 Theresa Garbarino- May <br /> ( Please print name of individual signing) <br /> and my relationship to the entity named above is <br /> Executive Director <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 24 <br />