Laserfiche WebLink
6 . Based on information and belief, the statement, which I have marked below, is true in relation <br /> to the entity submitting this swom statement. [Please indicate which statement applies . ] <br /> 3 <br /> Neither the entity submitting this sworn statement, nor any officers , directors, executives, <br /> partners, shareholders , employees, members, or agents who are active in management of the <br /> entity, have any relationships as defined in section 105 . 08 , Indian River County Code, with <br /> any County Commissioner or County employee. <br /> The entity submitting this sworn statement, or one or more of the officers , directors, <br /> executives ; partners , shareholders , employees, members , or agents, who are active in <br /> management of the entity have the follovrrg relationsl'ups v�utii a COurity COii2riuSSioiicr or <br /> County employee : <br /> Name of Affiliate Name of County Commissioner <br /> Relationship or entity or employee <br /> gnature) <br /> 7% <br /> c , <br /> (Date) <br /> STATE OF <br /> i <br /> COUNTY OF �. `r <br /> The foregoing instrument was acknowledged before me this ` day of 20 <br /> _ <br /> OS by who is personally known o me�W <br /> has-p -o as i on. <br /> / NOTARY PUBLIC <br /> ' Sd"G <br /> PRINT: <br /> i, <br /> Notary Public, State at large <br /> ® ■ <br /> TRIClA MARIE URBAN My Commission Expires : <br /> NOTARY PUBLIC - MINNESOTA <br /> _ MY COMMISSION EXPIRES (Seal) <br /> JANUARY 31 , 2008 <br /> Page 21 of 30 <br /> F:\Purchasing\Bids\20042005 FY (7000)\7076 Hurricane Debris Removal Bid\7076 Hurricane Debris Removal Bid. doc <br />