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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 Florida <br />COUNTY OF St. Lucie <br />Name of County Commissioner <br />or employee <br />Relationship <br />ignature) <br />J,.rr 271, tat k <br />(Date) <br />The foregoing instrument was acknowledged before me this 27th day of June 20 18� by <br />Christopher A. Long , who is personally known to me or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIGN: Iyr,,o' o'sumt—' <br />PRINT: m \AJ So 1401-- <br />Not ry Public, State at large <br />My Commission Expires: <br />(Seal) Timothy W. Sutton <br />A"'Vce <br />gsNOTARY PUBLIC <br />STATE OF FLORIDA <br />Comm#GG185982 <br />Is�Expires 3/2012022 <br />00452-2 <br />F:\PublicWorks\ENGINEERING DIVISION PROJECTS\1765 Sebastian Corners Roof Replacement\1-Admin\Bid Documents\Master Contract <br />Documents\Master Contract Documents\00452 Disclosure of Relationships.doc <br />