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Name of Affiliate Name of County Commissioner Relationship <br /> or entity or employee <br /> (Signage)" ' <br /> (Date) <br /> STATE OF <br /> COUNTY OF <br /> The foregoing instrument was acknowledged before me this day of 20LL, by <br /> who is pdii k� <br /> "nUtil owoto me or who has produced <br /> as identification. <br /> NOTARY PUBLIC <br /> SIGN: <br /> PRINT: <br /> Notary Public, Sfate at large <br /> MY .ssion Expires: <br /> 'J'RyP& <br /> Notary Public State Of Florida <br /> (Sea V� William T Barry <br /> N 4' MY Commission DD978547 <br /> of Expires 06/11/2014 <br /> 00452-2 <br /> FAPublic Works\ENGINEERING DIVISION PROJECTS\1 21 0-Sandridge Driving Range Tee Renovation\Admim\bid documents\00452 Disclosure of <br />