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The entity submitting this swom statement, or one or more of the officers , directors , <br /> executives , partners , shareholders , employees , members , or agents who are active <br /> in management of the entity have the following relationships with a County <br /> Commissioner or County employee: <br /> Name of Affiliate Name of County Relationship <br /> or Entity Commissioner or employee <br /> 1 . <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5 . <br /> 6 . <br /> 7 . <br /> 8 . <br /> (signature) <br /> (date) <br /> STATE OF r <br /> COUNTY OF in <br /> Personally appeared before me , the undersigned authority, <br /> who after first bein s or r� by me , affixed his/her si nature in the space provided above on this <br /> day of � 2�` , 20 V 18 . <br /> &44Vtn q.. <br /> NotaryPublic, State at large <br /> My Commission Expires : <br /> END OF SECTION <br /> sa ALYSA A. COMFORT <br /> jQ Commission DD 764786 <br /> ` r Expires May 26, 2012 <br /> eaaaeanwTwyFain trune. eoo,9es7oti <br /> -- 00452 - Disclosure of Relationships REV 04-07 <br /> 00452 - 2 <br /> F:tEngineering\capital Projectst0206 5th ST SW & 43rd AVE Bridge Replacement & RoadwaY ImproremantslCONTRACT BID100452 - Disdosure of Relationships REV 04- <br /> n9 A <br />