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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 />DECEMBER 3, 2014 <br />(Date) <br />STATE OF FLORIDA <br />COUNTY OF ST. LUCIE <br />The foregoing instrument was acknowledged before me this 3rd day of DECEMBER <br />LARRY T. DALE <br />,20 14. by <br />who is personally known to me or who has produced <br />as identification. <br />PRINT: AN70/N6"---77 "e1c,e5DA/ <br />Notary Public, State at large <br />My Corr It of 41'4%46 Petersc <br />NOTARY PUBLIC <br />(Seal) _ / STATE OF FLORIDA <br />Corm FF146809 <br />Expires 9/29/2018 <br />00452-2 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1314-107th Ave Milling_90th St to 94th SMdmin\bid documents\Master Contract <br />Documents\00452 Disclosure of Relationships.doc <br />