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Exhibit G <br /> The corporate officers are as follows: <br /> President: Jol�n S.Latshaw <br /> Vice President: <br /> Secretary: <br /> C. PARTNERSHIP OR LLC <br /> The partners or members are as follows: (Attach additional sheets if necessary) <br /> John S. Latshaw 1370 Florian Drive,Mt.Zion 62549 217-454-1226 <br /> Name Home Address&Telephone <br /> Name Home Address &Telephone <br /> Name Home Address&Telephone <br /> The business address is 6275 E.US Route 36 Decatur Illinois 62521 <br /> Telephone: 217-864-2940 F�; <br /> D. INDNIDUAL PROPRIETORSHIP <br /> The business address is <br /> Telephone: Fax: <br /> My home address is <br /> Telephone: F�; <br /> SECTION II. NON-COLLUSION STATEMENT (so ti,cs iosi3;65 ILCS 5/3.1-55-10) <br /> A. This bid is made without any connection or common interest in the profits with any other <br /> person other than the Professional Service Provider except as listed on a separate attached <br /> sheet to this affidavit. <br /> Check One: <br /> Others Interested in Contract X None <br /> B. No department director or any employee or any officer of the City of Decatur has any financial <br /> interest,directly or indirectly, in the award of this contract except as listed on a separate attached <br /> sheet to this affidavit. <br /> G-2 <br />