8-00452 - Disclosure.pdf
PDF 136 KB Posted
- Solicitation number
- 2025060
- Issued by
- Indian River County, Florida
About this file
This document is a Disclosure of Relationships form from Indian River County, Florida, designed to ensure transparency and potential conflicts of interest for entities doing business with the county. The form requires businesses to disclose any familial or professional relationships between their officers, directors, executives, partners, shareholders, employees, members, or agents with County Commissioners or County employees. The disclosure covers an extensive list of relationships, including immediate and extended family connections such as parents, siblings, in-laws, step-relatives, and grandparents.
The form provides two options for disclosure: either affirming that no relationships exist with county officials, or detailing specific relationships if any are present. By signing the document, the submitter swears under penalty of perjury that the information provided is true. The form is part of Section 105.08 of the Indian River County Code, which aims to maintain ethical standards and prevent potential conflicts of interest in county business transactions.
View the file
Other files
Show all 15
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 – 00452-1
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 105.08, 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, 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 105.08, 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. I hereby swear, under penalty of perjury, the information provided on this form is true.
(Signature)
(Date)
| 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: |
| CheckBox1: Off |
| CheckBox2: Off |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
| Text7: |
| Text8: |
| Text9: |
| Text10: |
| Text11: |
| Text12: |
File details come from the government source that posted it. Updated .