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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 Martin <br />Name of County Commissioner <br />or employee <br />Relationship <br />Sig�iiature) <br />1/16/20 <br />(Date) <br />The foregoing instrument was acknowledged before me this 16th day of January 12020, by <br />Peggy Sheltra , who is personally known to me or who has produced <br />as identification. <br />NOTARY PU IC <br />SIGN: Y- "atC/k/t <br />kj <br />PRINT: Andrea Bourhault <br />Notary Public, State at large <br />My Commission Expires: April 29, 2023 <br />(Seal) <br />:•«"Y'`!t ANDREABOURGAULT <br />A? My COMMISSION N GG 506312 <br />'•. .oP ; EXPIRES: Apel 29, 2023 <br />�"�` BorMed Thru <br />Nobq PubNc Underrrkera <br />00452-2 <br />FAPublic Works\ENGINEERING DIVISION PROJECTS\1503-43rd Ave Swk_Airport Dr to 41st St\1-Admin\Bids\Bid Documents\Master Contract <br />Documents\00452 Disclosure of Relationships.doc <br />