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Exhibit G <br /> Exhibit G <br /> CONSIILTING ENGINEER'S DISCL4SURE AFFIDAVIT <br /> (NOTE: This Affidavit rnust be completely fitled aut and signed by any garty doing business with the City. This <br /> Affidavit assists the City in rnaking determinations relative to conflict of interests and other laws) <br /> STATE OF ILLINOIS ) <br /> )ss. <br /> COUNTY QF^MAC�N ) <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> I,the undersigned, being duly sworn, do state as follows: <br /> A. _AECOM Techt�ical Services Inc. (Hereinafter "Consulting Engineer") is a: <br /> Catnpa��y Name <br /> {Place Inark in frant of apprapriate type of business} <br /> _X,Corporation(if a Corporation, carnpte#e B} <br /> Partnership(if a Partnership, co�nplete C) <br /> Limited I�iability Corparation(if an LLC, complete C) <br /> Individual Proprietorship(if an Individual, complete D) <br /> Consulting Engineer's Federal '1'ax Identification Number is 95-2661922 <br /> B. CORPORATION <br /> The State of Incorporation is Califarnia <br /> Registered Agent of Corporatian in Illinois: Business Infor�nation{If Different from Above}: <br /> John Schwalbach S 15 S. Flower St►•eet <br /> Name Company Address, Principai Of�ce <br /> 345 E. Ash Ave Suite B Los Angeles,CA 90071-220t <br /> Address City, State, Zip <br /> Decatur IL 62526 213-593-8000 <br /> City, State,Zip Teiephone Facsimile <br /> 217-875-4840 www.aecom.com <br /> Tele hone Website <br /> The carporate officers are as fallows: <br /> G-1 <br />