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Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> 1 Not Applicable <br /> 1 <br /> ign ture) <br /> ° 6 � oAZ <br /> (Date) <br /> STATE OF Florida <br /> COUNTY OF Orange <br /> The foregoing instrument was acknowledged before me this day of c� un , 20ZL, by <br /> who is personally known to me pr who has produced <br /> as identification . <br /> NOTARY PUBLIC <br /> 11 <br /> SIGN : ^ ( ' ,� t .. 'tt.�.z. . _. <br /> PRINT : <br /> 1 Notary Public, State at large <br /> My Commission Expires : <br /> IL <br /> (Seal) <br /> SOV e0 Notary Public State of Florida <br /> Desiree G Coleman <br /> �S My Commission EE023413 <br /> OF Expires 11 /14/2014 <br /> 1 <br /> 00452-2 <br /> FAPublic Works\ENGINEERING DIVISION PROJECTS\0391 -27th Ave at 5th St SW1Admim\Contract Documents\00452 Disclosure of <br />