Laserfiche WebLink
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 />N/A <br />Relationship <br />PORA <br />o : Z _ Anthony McDougle, Presid nt <br />a. . <br />SEAL ; o _ (Signature) <br />6/29/20 <br />?006(Date) <br />1 \�`� Date <br />STATE OF Alabama <br />COUNTY OF Lauderdale <br />Sworn to (or affirmed) and subscribed before me by means of El physical presence or ❑ online notarization, <br />this June 29 day of 20 20 , by _ Anthony McDougle (name of person making <br />statement). <br />6nt <br />4tic' <br />Connie Sue Dill <br />(Signature of Notary Public - State of Florida) <br />(Print, Type, or Stamp Commissioned Name of Notary Public) <br />��¢nr1nin,,,�i <br />❑ who is personally known to me or ❑ who has produced 10 ".4 _ _S (/,0111 � <br />as identification. oma -,,o <br />o <br />Z 7 <br />UBOG <br />END OF SECTION STATE.����P�ee' <br />F:\PublicWorks\ENGINEERING DIVISION PROJECTS\1727 CR -512 EB & WB Bridge (88407879) Repairs\1-Admin\Bid DocumentsWaster Contract <br />Documents\00452 Disclosure of Relationships.doc 00452-2 <br />