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 />Name of County Commissioner Relationship <br />or entity or employee <br />STATE OF <br />COUNTY OF <br />(Signature) <br />; <br />;7 i�/ Li` <br />(Date) <br />The foregoing instrument was acknowledged before me this day of .;7' 20 17 by <br />/' <br />-- }� ) v ('� -/ , who is personally known to me or who has produced <br />as identification. <br />NOTARY PUBLIC <br />SIGN!. - / <br />PRINT: <br />00452-2 <br />?/?fir; / iii I,,,,• <br />Notary Public, State at large <br />My Commission Expires: <br />+b �e SHARON M. MORRIS <br />(Seal) ',,i;= * MY COMMISSION I FF 136734 <br />EXPIRES: July 31, 2018 <br />• 6t-' ONnled Toro Budget Notary Services <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1422 Aviation Blvd -20th Avenue Intersection Improvements\Admim\bid documents\Master <br />Contract Documents\00452 Disclosure of Relationships.doc <br />