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Indian River Board of County Commissioners <br /> 1840 25th Street <br /> Vero Beach , FL 32960 <br /> AUTHORIZATION FOR RELEASE OF INFORMATION <br /> Indian River County and r, ; 1 ; & .,J C�.'1��� ; Ct ,� rAgency/Individual <br /> are in the process ofnegotiationof a contract for <br /> C I'i1 i <br /> Indian River tounty is ! authorized to make an investigation of the <br /> Agency/Individual regarding its experience and qualifications . The <br /> Agency/Individual authorized the release of all relevant information concerning <br /> prior services furnished , contracts and background information of the <br /> Agency/Individual . The Agency/Individual authorizes any individual or <br /> organization that is in possession of relevant factual contract and background <br /> information , to release such data to Indian River County in response of the <br /> County's request. <br /> When an individual employee of the Agency signs Authorization for Release of <br /> Information , such individual authorizes the County to obtain relevant background <br /> information concerning such employee 's criminal record , if any, and such other <br /> information that may be relevant to employee 's good character and work <br /> experience . <br /> Authorization is given here by the Agency/Individual and such employees who <br /> execute this authorization with the understanding and limitation that Indian River <br /> County will utilize the information obtained for the purposes set forth herein and <br /> that such information shall not be disclosed to third parties except as provided by <br /> law. <br /> Name Agency/Individual SS ¢,. s &4Jf oe GA <br /> Print name � <br /> Name Employee Providing authorizatio 6/X So Pu Q,r -� <br /> Pri n m <br /> Signature (in blue ink) <br /> Date <br /> XI <br />