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Exhibit 1 Exhibit G <br /> Exhibit G <br /> CONSULTANT'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_Illinois ) <br /> ss. <br /> COUNTY OF Cook ) <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> I,the undersigned,being duly sworn, do state as follows: <br /> A. Teska Associates,Inc. (Hereinafter"Consultant")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 /> Consultant's Federal Tax Identification Number is <br /> B. CORPORATION <br /> The State of Incorporation is_Illinois <br /> Registered Agent of Corporation in Illinois: Business Information(If Different from Above): <br /> Lee M Brown 627 Grove St <br /> Name Company Address,Principal Office <br /> 65 E Monroe,Unit 4609 Evanston,IL 60201 <br /> Address City, State,Zip <br /> Chicago,IL 60603 847-869-2015 <br /> City, State,Zip Telephone Facsimile <br /> 847-563-9721 www.teskaassociates.com <br /> Telephone Website <br /> G-1 <br />