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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 />None <br />(Signature) <br />11/4/2015 <br />(Date) <br />STATE OF Florida <br />COUNTY OF St Lucie <br />The foregoing instrument was acknowledged before me this 4 day of November , 20 15, by <br />Scott Holmes <br />who is personally known to me <br />as identification. <br />Cocas Roos HEM <br />NOTARY PUBLIC <br />STATE OF FLORIDA <br />Carenit FF244966 <br />Expires 8/29/2019 <br />00452-2 <br />NOTARY PUBLIC <br />SIGN: „((`i�� <br />PRINT: l_eCt\+C-(-N • <br />or who has produced <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1232-1st St SW_43rd Ave Intersec ImprovWdmim\bid documentsWlaster Contract <br />Documents\00452 Disclosure of Relationships.doc <br />