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Docusign Envelope ID: E007A1C1-9A8047F6-9FF8-83E57097B514 <br />A TRUE COPY <br />'ERTIFICATION ON LAST PAGE <br />BUTLER, CLERK <br />Foreign Entity Ownership Affidavit <br />(required with every bid or offer, or contract which gives Entity access to an <br />individual's personal identifying information) <br />The undersigned, on behalf of the Entity listed below, hereby attests under penalty of perjury as <br />follows: <br />1. Entity is not owned by the government of a foreign country of concern as defined <br />in Section 287.138, Florida Statutes. (Source: § 287.138(2)(a), Florida Statutes) <br />2. The government of a foreign country of concern does not have a controlling <br />interest in Entity. (Source: § 287.138(2)(b), Florida Statutes) <br />3. Entity is not organized under the laws of, and does not have a principal place of <br />business in, a foreign country of concern. (Source: § 287.138(2)(c), Florida <br />Statutes) <br />4. Entity is not owned or controlled by the government of a foreign country of <br />concern, as defined in Section 692.201, Florida Statutes. (Source: § 288.007(2), <br />Florida Statutes) <br />5. Entity is not a partnership, association, corporation, organization, or other <br />combination of persons organized under the laws of or having its principal place <br />of business in a foreign country of concern, as defined in Section 692.201, <br />Florida Statutes, or a subsidiary of such entity. (Source: § 288.007(2), Florida <br />Statutes) <br />6. Entity is not a foreign principal, as defined in Section 692.2o1, Florida Statutes. <br />(Source: § 692.202(5)(a)(1), Florida Statutes) <br />7. Entity is in compliance with all applicable requirements of Sections 692.202, <br />692.203, and 692.204, Florida Statutes. <br />8. (Only applicable if purchasing real property) Entity is not a foreign principal <br />prohibited from purchasing the subject real property. Entity is either (a) not a <br />person or entity described in Section 692.204(1)(a), Florida Statutes, or (b) <br />authorized under Section 692.204(2), Florida Statutes, to purchase the subject <br />property. Entity is in compliance with the requirements of Section 692.204, <br />Florida Statutes. (Source: §§ 692.203(6)(a), 692.204(6)(a), Florida Statutes) <br />9. The undersigned is authorized to execute this affidavit on behalf of Entity. <br />DocuSigned by: <br />k., I ..n, &,&±)W <br />Jordan Mazur <br />Printed Name <br />General counsel <br />Title <br />Lively, Inc. <br />Entity <br />Date: 6/20/2025 <br />