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The entity submitting this sworn statement, or one or more of the officers, directors, executives, <br />partners, shareholders, employees, members, or agents, who are active in management of the entity <br />have the following relationships with a County Commissioner or County employee: <br />Name of Affiliate Name of County Commissioner Relationship <br />or entity or employee <br />N/A <br />v\,6„ <br />(Signature <br />November 19, 2014 <br />(Date) <br />STATE OF Florida <br />COUNTY OF Palm Beach <br />The foregoing instrument was acknowledged before me this 19th day of November <br />,2014 , by <br />Michael Neal , who is personally known to me or who has produced <br />as identification. <br />U NOTARY PUBLIC <br />SIGN: � _[ <br />L�y <br />PRINT: <br />00452-2 <br />Cynthia Perih <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) ; to 'F �, CYNTHIA L PERI -J <br />Notary Public - State of Florida '6 <br />My Comm. Expires Jun 17, 2015, <br />Commission # EE 101434 f' <br />Bonded Through National Notary Assn. <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1135-S County Park Intergeneratiional Rec Facility\Admim\bid documents\Master Contract <br />Documents100452 Disclosure of Relationships.doc <br />