Laserfiche WebLink
Exhibit G <br /> Exhibit G <br /> CONSULTING ENGINEER'S DISCLOSURE AFFIDAVIT <br /> (NOTE: This Affidavit must be completely filled out and signed by any party doing business with the City.This <br /> Affidavit assists the City in making determinations relative to conflict of interests and other laws -if questions <br /> contact the City of Decatur Legal Department at 217/424-2807.) <br /> STATE OF WISCONSIN ) <br /> ss. <br /> COUNTY OF DANE ) <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> I,the undersigned, being duly sworn, do state as follows: <br /> A. Strand Associates, Inc®(Hereinafter"Consulting Engineer") is a: <br /> Company Name <br /> (Place mark in front of appropriate type of business) <br /> X_Corporation(if a Corporation, complete B) <br /> Partnership(if a Partnership, complete C) <br /> Limited Liability Corporation(if an LLC, complete C) <br /> Individual Proprietorship(if an Individual, complete D) <br /> Consulting Engineer's Federal Tax Identification Number is 39-1020418 <br /> B. CORPORATION <br /> The State of Incorporation is Wisconsin <br /> Registered Agent of Corporation in Illinois: Business Information(If Different from Above): <br /> Darcie Gabrisko, Strand Associates, Inc.® Strand Associates, Inc. <br /> Name Company Address, Principal Office <br /> 1170 South Houbolt Road Madison, WI 53715 <br /> Address City, State,Zip <br /> Joliet, IL 60431-9063 608-251-4843 608-251-8655 <br /> City, State, Zip Telephone Facsimile <br /> 815-744-5867 www.strand.com <br /> Telephone Website <br /> G-1 <br />