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The entity submitting this sworn 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 <br />or Entity <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />Name of County <br />Commissioner or employee <br />Relationship <br />(si nature) <br />IIIO1aoo <br />(date) <br />STATE OF 1 (9.. LtcI Ci <br />COUNTY OF jrl d LC(Y1 J 1 W-14 <br />Personally appeared before me, the undersigned authority, ii‘ v\r)rc.t` <br />who a er first bein• wom by me, affixed his/her signpture in the space provided above on this <br />day of . 2 /i , 20 DO <br />Public, St-' at Targe <br />Commission pires: <br />GLORIA J. KU2MICK <br />MY COMMISSION 0 DD 719964 <br />EXPIRES: May 26.2009 <br />Bonded Tiro Notary Punk Underwriters <br />END OF SECTION <br />00452-2 <br />H\Projects\0741\Bidding Contract Specifications\Spec Template\2007\O04520isdosure of Relationships.doc <br />