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SECTION 00452
<br />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 />This sworn statement is submitted with Bid, Proposal or Contract No. 2008027 for the South RO Water
<br />Treatment Plant Improvements.
<br />1. This sworn statement is submitted by:
<br />TC- Snd2 ►A�3
<br />(Name of entity submitting sworn statement)
<br />whose business address is: C,I(*il Cowa r e i s &"a C J-- (oo
<br />k4A00 and
<br />(if applicable) its Federal Employer Identification Number (FEIN) is cy-oa77J3.23 (If the
<br />entity has no FEIN, include the Social Security Number of the individual signing this
<br />sworn statement 1
<br />2. My name is
<br />'k..
<br />(Please print name of individual signing)
<br />and my relationship to the entity named above is NcsileAi
<br />3. 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 />4. I understand that the relationship with a County Commissioner or County employee that must be
<br />disclosed is as follows:
<br />Father, mother, son, daughter, brother, sister, uncle, aunt, first cousin,
<br />nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-in-
<br />law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother,
<br />stepson, stepdaughter, stepbrother, stepsister, half brother, half sister,
<br />grandparent or grandchild.
<br />5. Based on information and belief, the statement which I have marked below is true in relation to the
<br />entity submitting this sworn statement. Please indicate which statement applies.
<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 any
<br />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 following relationships with a County Commissioner or
<br />County employee:
<br />044572017
<br />00452-1
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