Laserfiche WebLink
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 /> dff <br /> 1 . This sworn statement is submitted with RFP No . S 494 for <br /> 2 . This sworn statement is submitted by: <br /> ( Name of entity submitting Statement) <br /> whose business address is : <br /> P o• ev X s a s <br /> ILOOlicn.9abxoi , FL 3 'fr.r8' and <br /> (if applicable ) <br /> its Federal Employer Identification Number (FEIN ) <br /> is32 1111111111, <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 <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 <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 <br />