6-Disclosure.pdf
PDF 128 KB Posted
- Attached to
- New Metal Roof for Fire Station 4 & 5
- Solicitation number
- 2026008
- Issued by
- Indian River County, Florida
About this file
This is a Disclosure of Relationships form required by Indian River County, Florida, for bidders on the New Metal Roof for Fire Station 4 & 5 project. The document is a sworn statement that requires the submitting firm to disclose any relationships between the entity, its officers, directors, executives, partners, shareholders, employees, members, or agents active in management and any Indian River County Commissioners or County employees. The disclosure must identify specific relationships as defined in Section 105.06 of the Indian River County Code, which includes immediate family members, in-laws, step-relations, half-siblings, and grandparents or grandchildren. Bidders must certify under penalty of perjury that either no such relationships exist or, if they do exist, provide detailed information including the names of affiliated parties, the names of County officials or employees involved, and the nature of the relationship.
The form requires bidders to notify the County's purchasing department at purchasing@indianriver.gov if any new affiliate relationships are identified after submission. This disclosure requirement is a standard conflict-of-interest mechanism designed to ensure transparency and prevent favoritism in the procurement process for this roofing project serving Fire Stations 4 and 5. Failure to disclose known relationships or providing false information on this sworn statement constitutes perjury under Florida law.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 8-Lobbying.pdf | ||
| 1-2026008 - New Metal Roof for Fire Station 4 5.pdf | ||
| 4-Bid Bond.pdf | ||
| 2-Sample Agreement and Contract Documents.pdf | ||
| 5-Bid Compliance Form.pdf | ||
| 11-Warranty Information Form.docx | DOCX document | |
| 3-Anti-Human Traffic.pdf | ||
| 7-Drug Free.pdf | ||
| 12-Permit Fees.pdf | ||
| 9-Qualifications Questionnaire.pdf | ||
| 10-Scrutinized.pdf |
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 purchasing@indianriver.gov.
7. I hereby swear, under penalty of perjury, the information provided on this form is true.
(Signature)
(Date) mailto:purchasing@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: |
| Textfield: |
| Textfield-0: |
| Textfield-1: |
| Textfield-2: |
| Textfield-3: |
| Textfield-4: |
| Textfield-5: |
| Textfield-6: |
| Textfield-7: |
| Date: |
File details come from the government source that posted it. Updated .