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Exhibit G <br /> Exhibit G <br /> �QNSULTING ENGINEER'S DISCLOSUR.E AFFIT3AVIT <br /> (N4TE: This Affidavii anust be completeiy�lled out and sig,ned by any party doing business with the City. This <br /> Affidavit assists the City in rnaking determinations relative to conflict af interests and other laws-ifquestions <br /> contact the City af Decatur Legal Departmenx at 21714�4-2807.} <br /> STAT'E C3� INDIANA ) <br /> }ss. <br /> CC1UTdTY OF MONROE } <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> l,#he undersigned, bein�duly sworn,dc�state as foliaws: <br /> A, iNTERA Inco arated (Hereinafter'"Consulting Engineer")is a: <br /> Company I'+Came <br /> {Place mark in front of apprapriate type of business} <br /> _x CarporatiQn(if a Corporation,complete B} <br /> ParMership(ifa Partnership,camptete C} <br /> Litnited Liability Carporatian(if an LLC,ccsmplete C) <br /> [ndividual Praprietorship{if an Individual,cornplete D) <br /> Cortsulting Engineer's Federal T�Identification Number is 74-3030638 <br /> B. CQRP4RATION <br /> The State af lncorparation is TEXAS <br /> Registered Agent af Corparation in Illinois: Business Informa#ion{If Different from Abovej: <br /> Re�istared Agent SoIutions, Inc. <br /> ��� Company Address, Principal(7�ce <br /> 90l S.2°d Stt'eE:t, Ste.2U I <br /> Address City, State, 'Lip <br /> Sprin�field, tL 6'�704 <br /> City, State,Zip Telephone Facsimile <br /> Tele hone t�ebsite <br /> G-1 <br />