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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 />Name of County Commissioner <br />or employee <br />STATE OF <br />1. <br />COUNTY OF AZ_,t.,���( <br />Relationship <br />(Signature) <br />/O/F:o /i�- <br />/�l�e) <br />The foregoing instrument was acknowledged before me this'20 day of , 20� by <br />/`-- ~� <br />� � 4 �'� y �-- ,who is pe�on�cnowl�e or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIG <br />,G ANDREW T. HOLLAND ` <br />®� Notary Public, State of Florida r / <br />Commission# GG 354742 PRINT: �f` �t XX4 <br />My comm. expires July 16, 2023 Notary Public, State at large <br />My Commission Expires: <br />(Seal) <br />00452-2 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\0853-43rd AVE 18th ST to 26th ST (Arcadis)\1-Admin\Bid Documents\Master Contract <br />Documents\00452 Disclosure.of Relations hips.doc <br />