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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 />Naive of Affiliate <br />or entity <br />Name of County Commissioner <br />or employee <br />STATE OF tCXt JQ <br />COUNTY OF Pg Yn 'C )R -O -Cl <br />Relationship <br />(Si&nature) <br />10/24/2018 <br />(Date) <br />The foregoing instrument was acknowledged before me this V� day of �--� , 20 l e by <br />Sc0 �O ArIS047 , who is personally known to me or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIGN:�� L1 <br />PRINT: <br />Notary Public, State at large <br />My Commission Expires: <br />(Seal) ot�Y P�B�,c YAMILETH HOFFMAN <br />* * MY COMMISSION # GG 021598 <br />Nr c� EXPIRES: August 15, 2020 <br />Bonded Thru Budget Notary Services <br />00452-2 <br />F:\PublicWorks\ENGINEERING DIVISION PROJECTS\1748 Gifford Neighborhood - 45th Street Beautification Project Phase 11\1-Admin\RE-bids\Bid <br />Documents\Master Contract Documents\00452 Disclosure of Relationships. doc <br />