3-Form - Disclosure Form.pdf
PDF 130 KB Posted
- Attached to
- Property Appraiser Office Remodel
- Solicitation number
- 2026031
- Issued by
- Indian River County, Wilton Manors City, Florida
About this file
This is a Disclosure of Relationships form required by Indian River County, Florida for vendors and contractors bidding on the Property Appraiser Office Remodel project in Vero Beach. The form mandates that all bidding entities disclose any familial, business, or management relationships between the firm's officers, directors, executives, partners, shareholders, employees, members, and agents with Indian River County Commissioners or County employees. The disclosure requirements cover a comprehensive list of relationships including immediate family members, in-laws, step-relations, half-siblings, and grandparents/grandchildren, as defined under Section 105.06 of the Indian River County Code.
Bidders must certify under penalty of perjury that either no such relationships exist or provide detailed information identifying any affiliated individuals, the specific County Commissioner or employee involved, and the nature of the relationship. The form requires completion and signature by an authorized representative of the bidding firm, and any newly identified affiliate relationships discovered after submission must be reported to procurement@indianriver.gov. This disclosure is a standard ethics and conflict-of-interest compliance requirement for the competitive bidding process related to the approximately 1,410 square foot interior renovation of the Property Appraiser Office located at 1801 27th Street, Vero Beach, Florida.
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Text version
Disclosure of Relationships -1
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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