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1 <br /> 1 <br /> (Please attach a copy of the final <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 OTHER OFFICER <br /> AUTHORIZED TO ADMINISTER OATHS , <br /> 1 . This sworn statement is submitted with Bid, Proposal or Contract No. 5071 <br /> for Fencing at the Hallstrom Farmstead Conservation Area <br /> 2 . This sworn statement is submitted by: �/f 77C� a/s � c <f <br /> (Name of entity submitting Statement) <br /> whose business address is : <br /> /U - � S <br /> and (if applicable) its Federal Employer Identification Number (FEIN) is <br /> (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn <br /> statement �� ) <br /> 3 . My name is -✓ /tel. z <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above s <br /> 4 . I understand that an "affiliate" as defined in Section 105 . 08 , Indian River County Code , 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 be <br /> disclosed as follows : <br /> Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, <br /> wife, father-in-law, mother-in-law, daughter-in-law, 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 /> Page 23 of 38 <br />