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_ (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 <br /> OFFICER AUTHORIZED TO ADMINISTER OATHS . <br /> 1 . This sworn statement is submitted with Bid, Proposal <br /> or Contract No . 7076 j <br /> for d .l a$ Vtd' "moifi <br /> i �`� /R � �: 6���i�Lx9t t . .y a E <br /> 2 . This sworn statement is submitted by : <br /> C 'af< <br /> (Name of entity submitting Statement) <br /> whose business address is : <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 <br /> i- <br /> individual signing this swom statement ) <br /> 3 . , My name is In fio r-- <br /> (Please print name of individual signing) <br /> and my relationship to the entity named above is <br /> 4 . 1 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 <br /> be disclosed 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 /> I <br /> i <br /> Page 20 of 30 <br /> FAPurchasing\Bids\2004-2005 FY (7000)\7076 Hurricane Debris Removal Bid\7076 Hurricane Debris Removal Bid.doc <br />