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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 />voo�tiuuuntua���i <br />GpgP <br />�{' `• <br />SEAL <br />1983 <br />'.� . O1RI� P•' • �.� <br />STATE OF Florida <br />COUNTY OF Broward <br />,�12 �, <br />(Signature) <br />03.29.17 <br />(Date) <br />The foregoing instrument was acknowledged before me this 29 day of _ March 2017, by <br />Robert P. Kornahrens <br />who is personally known to me or who has produced <br />as identification. <br />OTARY PUBLIC <br />SIGN: <br />P Williams <br />Notary Public, State at large <br />My Commission Expires: 08.24.17 <br />(Seal) <br />1�'Y erg FAITH W WAMS <br />MY COMMISSION 0 FF 040175 <br />EXPIRES: August 24, 2017 <br />' Qf Bonded Thru Notary Pubric Underwdten: <br />00452-2 <br />FAPubiic Works\ENGINEERING DIVISION PROJECTS\1705 Bulldings A & B Roof Replacement\1-Admin\Bid DocumentsWaster Contract <br />Documents\00452 Disclosure of Relagonships.doc <br />