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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 in <br />management of the entity have the following relationships with a County Commissioner or <br />County employee: <br />Name of Affiliate Name of County Commissioner <br />or entity or employee <br />STATE OF Florida <br />COUNTY Of Broward <br />Relationship <br />Signature) <br />Der 11, 2012 <br />(Date) <br />The foregoing instrument was acknowledged before me this 11tday ofDecember 2012 by <br />Casey R. Sullivan who is personally known to me or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIGN: /'o G" �'ar� <br />PRINT: <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) <br />00452-2 <br />K <br />W. G. PULSFORDMY COMMISSION # EEI 16883 EXPIRES: July 28, 2015 F7. Notary Disc t Ann. Co.Y <br />