2-00452 - Disclosure.pdf
PDF 131 KB Posted
- Attached to
- Indian River County Fire/EMS Station #15
- Solicitation number
- 2026026
- Issued by
- Indian River County, Wilton Manors City, Florida
About this file
Summary of 2-00452 - Disclosure.pdf
This disclosure document pertains to Indian River County, Florida's Fire/EMS Station #15 construction project. The project encompasses the construction of a new 9,983 square foot Fire Station/EMS facility located at 9010 87th Street in Vero Beach, Florida. The building will feature a single-story concrete block structure with a standing seam metal roof, incorporating separate spaces for dormitory, office, and facility areas, along with equipment storage and a four-bay apparatus room. Civil site work includes construction of a concrete driveway and parking lot, installation of drainage structures, development of a stormwater detention basin, utility pipework for forcemains and watermains, and construction of a lift station.
The document serves as a disclosure filing for the project, establishing the foundational scope and specifications for the proposed construction work. Additional details regarding pricing terms, contract award timelines, bidding procedures, site visit requirements, and other procurement-specific information would be contained in supplementary procurement documents associated with this contract opportunity.
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Text version
Disclosure of Relationships -1
00452-DISCLOSURE OF RELATIONSHIPS
1. This sworn statement is submitted by (firm name):
whose business address is: .
2. My name is and my relationship to the entity named above is .
3. I understand that as defined in Section 105.06, Indian River County Code, the term
“affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the entity.
4. I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows:
Self (current county employee or commissioner), father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild.
5. Based on information and belief, the statement, which I have marked below, is true in relation to the entity submitting this sworn statement. [Please select either a. or b.]
a. Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, have any relationships as defined in section 105.06, Indian River County Code, with any County Commissioner or County employee; or,
b. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents, who are active in management of the entity have the following relationships with a County Commissioner or County employee:
Name of Affiliate of entity Name of County Commissioner or employee Relationship
6. Should a new affiliate relationship be identified after the submittal of this form, I will notify procurement@indianriver.gov.
7. I hereby swear, under penalty of perjury, the information provided on this form is true.
(Signature)
(Date) mailto:procurement@indianriver.gov
| 1 This sworn statement is submitted by firm name: |
| whose business address is: |
| 2 My name is: |
| my relationship to the entity named above is: |
| a: |
| b: |
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