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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 Name of County Commissioner Relationship <br />or entity or employee <br />(Signature) <br />6/19/15 <br />(Date) <br />STATE OF FLORIDA <br />COUNTY OF MARTIN <br />The foregoing instrument was acknowledged before me this 19_ day of JUNE 20 15, by <br />MARGARET FENTON <br />, who is personally known to me or who has produced <br />11. as identification. <br />00452-2 <br />NOTARY PUBLIC <br />SIGN: kI cOt& to d <br />PRINT: Sa(vado <br />Notary Public, State at large <br />My Commission Expires: t�c. F lo, Z0t% <br />(Seal) <br />Py s NICOLE SALVADO <br />MY COMMISSION i FF 163941 <br />; EXPIRES: December 16, 2016 <br />....... Bonded Thru Pickard Insurance Agency <br />F:\Public Works\ENGINEERING DIVISION PROJECTS \1506 -Gifford Neighborhood 45th St Beautification \Admin\bid documents\Master Contract <br />Documents\00452 Disclosure of Relationships.doc <br />