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The entity submitting this sworn statement, or one or more of the officers, directors, <br />executives, partners, shareholders, employees, members, or agents who are active <br />in management of the entity have the following relationships with a County <br />Commissioner or County employee: <br />(signature) <br />(date) <br />1 STATE OF <br />�L <br />COUNTY OF <br />Personally appeared before me, <br />the undersigned authority, S <br />who sf�er first being sworn. by me, affixed his/her signature in the space provided above on thisof 0C4: <br />UzyftIWV l'0 l4,>jq hg f- )qP?coq01 L%P ,` W111 <br />Notary R tic, State at 'ozao�r t'.1 <br />1U nN.4.WUki0•Wy:, <br />O IJOh )n alr�„ Jrl�ind Alplp '� <br />Myr fission Expire: - �s <br />N :, , <br />ef <br />END OF SECTION <br />00452 - Disclosure of Relationships REV 04-07 <br />00452-2 <br />F:\Engineering\Capital Projects\0803 17th Lane SW Roadway Improvements from 27th Ave to approx. 900 LF east of 27th Ave\0803 Contract Documents\00452 - D sclosure <br />DCS/ nd_n7 rimr. <br />