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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 <br />or entity <br />STATE OF <br />COUNTY OF <br />FLORIDA <br />MARTIN <br />Name of County Commissioner <br />or employee <br />The foregoing instrument was acknowledged before me this <br />Relationship <br />(Si ature) <br />9.17.19 <br />(Date) <br />17 SEPTEMBERday of 92019 by <br />MARGARET FENTON , who is personally known to me or who has produced <br />as identification. <br />SIGN; <br />00452-2 <br />NOTARY <br />Notary Public, State al large <br />My Commission Expires: <br />(Seal) t Ashley Pauly <br />NOTARY PUBLIC <br />s STATE OF FLORIDA <br />Corton# GG266081 <br />e g� Expires 10/14/2022 <br />F:\Public Woiks\ENGINEERING DIVISION PROJECTS\1806 Indian River Blvd and Grand Harbor Blvd -Mast Arms\1-Admin\Bid Documents\Master <br />Contract Documents Re-Bid\00452 Disclosure of Relationships.doc <br />