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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 />June <br />, 2015 <br />STATE OF Florida <br />COUNTY OF S t . Lucie <br />The foregoing instrument was acknowledged before me this 3rd day of <br />Larry T. Dale <br />(Date) <br />June <br />,20 15 by <br />who is personally known to me or who has produced <br />as identification. <br />SIGN: <br />NOTARY PUB <br />PRINT: <br />00452-2 <br />Antoinette Peterson <br />PUBLIC <br />Notary Public, <br />My Commissi <br />(Seal) <br />TE OF FLORIDA <br />:Comrngt FF146809 <br />Expires 9/29/2018 <br />F:1Public Works\ENGINEERING DIVISION PROJECTS\1317-85th St Miiling_91 st Ave to 101st AveAdminlbid documentstMaster Contract <br />Documents\00452 Disclosure of Relationships.doc <br />