7-Disclosure Form.pdf
PDF 130 KB Posted
- Solicitation number
- 2026033
- Issued by
- Indian River County, Florida
About this file
This is a Disclosure Form submitted by a bidder for the Administration Buildings A & B Entrance Restoration Re-Bid project with Indian River County, Florida. The project involves restoration of entranceways at the County Administration Complex located at 1801 and 1800 27th Street, Vero Beach, Florida. Work includes demolition and removal of existing material, replacement of concrete, and installation of trench drain systems across three entrance areas as shown in project drawings. The contractor must provide all necessary equipment, materials, and labor for successful project completion.
The disclosure form serves as documentation of the bidder's compliance with applicable requirements and qualifications to perform the work. The form establishes the bidder's eligibility to submit a bid for this re-bid opportunity and confirms adherence to any regulatory or procedural mandates set forth by Indian River County. As a disclosure document, it likely contains certifications, representations, or acknowledgments required as part of the bidding process, though specific pricing terms, contract duration, and award timeline information would be contained in separate bid documents or contract specifications.
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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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