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SWORN STATEMENT UNDER SECTION 105 . 08, INDIAN RIFER COUNTY CODE. ON <br /> ,. DISCLOSURE OF RELATIONSHIPS <br /> THIS FORM MUST BE SIGNED IN THE PRESENCI OF A NOTARY PLBLIC OR OTHER <br /> r OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement is submitted with Bid, Proposal or Contract No . 200 ' 033 <br /> r for Gifford Park Secunty House <br /> 2 . This swomstatementissubmittedby: Passage Island Homesf Inc <br /> r <br /> (Name of entity submitting Statement) <br /> _ whose busness address is : <br /> 1910 82nd Avenue # 205 , Vero Beach , FL 32966 and (if <br /> r applicable) its Federal EmployerldentifoationNumbei- (FEL\) is 59 - 3456562 (if the entity has <br /> no FEIN, include the Social Security 'Number of the individual signing this sworn statement <br /> .. J <br /> 3 . N2ynameis Brian F . Adams <br /> r (Please print name of individual signing) <br /> and my relationship to the entity named above is Pres i den t <br /> 4. 1 understand that an "affiliate" as defined in Secticn 105 . 08 , Indian River County Code, means : <br /> The term "affiliate" includes those officers, Lectors, 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 be <br /> disclosed as follows : <br /> r <br /> Father, mother, son, daughter, brother, sister, untie, aunt; first cousin, nephew, niece, husband, <br /> wife, father-in-law, mother-in-law, daughter-in-lacy, son-in-law, brother-in-law, sister-in-law; <br /> stepfather, stepmother, stepson, stepdaughter, stepbrother; stepsister, half brother, half sister, <br /> grandparent, or grandchild. <br /> r 6 . Based on information and belief the statement, which I have marked below, is true in relation to <br /> the entity submitting this sworn statement. [Please indicate which statement applies. ] <br /> r xx Neither the entity submitting this sworn statement, nor any officer, directors, <br /> executives, parmers, shareholders, employees, member, or agents who are active in <br /> r management of the entity; have any relationships as defined in section 105 . 08 , Indian River <br /> County Code, -Mth any County Commissioner or County employee. <br /> The entity submitting this sworn statement, or one or more of the officers, directors, <br /> executives, Partner, shareholders, employees, members, or agents, who are active in <br /> management of the entity have the following relationships with a County Commissioner or <br /> .. County employee : <br /> Pone 2d nFACI <br />