Laserfiche WebLink
r <br /> . r <br /> 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 Bid, Bid <br /> or Contract No . for <br /> 2 . This sworn statement is submitted by : <br /> S /�r�Ns �U/L1� <nr/, / �C<iivOGUI/ES 1/VC[name of entity submitting sworn statement] <br /> whose business address is : o / I /3usljove" UQ. <br /> and (if applicable) its Federal Employer Identification Number <br /> (FEIN) IS : 13 - Z74oZLI S6 (If the entity has no FEIN, include the Social <br /> Security Number of the individual signing this sworn <br /> statement . ) <br /> 3 . My name is S tel✓ <br /> [please print name of individual signing] <br /> and my relationship to the entity named above is <br /> 4 . I understand that an " affiliate " as defined in Section 105 . 08 , INDIAN RIVER County <br /> Code, means : <br /> The term "affiliate " includes those officers, directors, <br /> executives , partners , shareholders , employees , members , <br /> 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 is 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 . <br />